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Burton LJ, Forster A, Johnson J, Crocker TF, Tyson SF, Clarke DJ. What influences provision of information about recovery on stroke units? A focused ethnographic case study. PATIENT EDUCATION AND COUNSELING 2024; 126:108331. [PMID: 38781751 DOI: 10.1016/j.pec.2024.108331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Patients and carers frequently report dissatisfaction with post-stroke information provision. This study aimed to develop an in-depth understanding of the factors influencing provision of information about recovery in stroke units. METHODS Focused ethnographic case-studies in two UK stroke units, including non-participant observations and semi-structured interviews with professionals, patients and carers, and documentary analysis. A Framework approach to analysis was undertaken. RESULTS Twenty patients, 17 carers and 47 professionals participated. The unpredictable recovery trajectory led professionals to present prognostic estimates as uncertain possibilities. The need to maintain patients' motivation limited sharing of negative predictions, and generic information over-emphasised the importance of therapy in recovery. A structured multidisciplinary team approach to delivering information improved consistency. Complex clinical reasoning was required to identify and meet patients' needs. Hospital environments and routines restricted opportunities for dialogue, particularly with carers. CONCLUSIONS The process of providing information about post-stroke recovery is complex, requiring enhanced clinical reasoning and communication. The challenges faced by professionals are numerous and if not addressed can result in suboptimal provision. PRACTICE IMPLICATIONS Professionals should develop a co-ordinated multidisciplinary approach to information provision; and engage in dialogue to ensure a tailored approach to identifying and meeting patients' and carers' information needs.
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Affiliation(s)
- Louisa-Jane Burton
- Academic Unit for Ageing & Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; Academic Unit for Ageing & Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Anne Forster
- Academic Unit for Ageing & Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; Academic Unit for Ageing & Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK; Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK; School of Public Health and Community Medicine, University of New South Wales, Australia
| | - Thomas F Crocker
- Academic Unit for Ageing & Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; Academic Unit for Ageing & Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sarah F Tyson
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - David J Clarke
- Academic Unit for Ageing & Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; Academic Unit for Ageing & Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Maloh HIAA, Jarrah S, Al-Yateem N, Ahmed FR, AbuRuz ME. Open visitation policy in intensive care units in Jordan: cross-sectional study of nurses' perceptions. BMC Nurs 2022; 21:336. [PMID: 36457014 PMCID: PMC9715403 DOI: 10.1186/s12912-022-01116-5] [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: 06/10/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Intensive care unit patients and families experience significant stress. It creates frustrations, nervousness, irritability, social isolation for patients, anxiety, and depression for families. An open visitation policy with no time or duration limits may assist in reducing these negative experiences. However, most Jordanian and regional hospitals within the Middle-East and Northern Africa (MENA) have not implemented this strategy. PURPOSE To evaluate nurse managers' and nurses' perspectives on the effects of an open visitation policy at intensive care units (ICUs) on patients, families, and nurses' care. METHOD A cross-sectional, descriptive, and comparative survey design was used. RESULTS A total of 234 nurses participated in the study; 59.4% were males, and 40.6% were females. The mean of their age was 28.6 years, with a mean of 4.1 years of experience. Nurses generally had negative perceptions and attitudes toward the open visitation policy and its consequences on the patient, family, and nursing care. CONCLUSIONS ICU managers and staff nurses did not favor implementing an open visitation in their units despite its known benefits, international recommendations, and relevance and compatibility with the local religious and cultural context. A serious discussion regarding this hesitation from the side of the healthcare professionals should be started to find a suitable solutions that consider the benefits of the open visitation policy and the challenges that prevent its implementation in the Jordanian and Arabic cultures.
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Affiliation(s)
| | - Samiha Jarrah
- grid.411423.10000 0004 0622 534XFaculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Nabeel Al-Yateem
- grid.412789.10000 0004 4686 5317Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Fatma Refaat Ahmed
- grid.412789.10000 0004 4686 5317Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, UAE ,grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Mohannad Eid AbuRuz
- grid.411423.10000 0004 0622 534XFaculty of Nursing, Applied Science Private University, Amman, Jordan
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Correia TSP, Martins MMFPS, Barroso FF, Valentim O, Fonseca C, Lopes M, Pinho LG. Safety and Family-Centered Care during Restriction of Hospital Visits due to COVID-19: The Experience of Family Members. J Pers Med 2022; 12:jpm12101546. [PMID: 36294685 PMCID: PMC9605370 DOI: 10.3390/jpm12101546] [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: 08/15/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Person and Family Centered Care (PFCC) has demonstrated important contributions to health care outcomes. However, in response to the need for safety due to the pandemic COVID-19, measures were taken to restrict hospital visits. So, the aim of this study was to understand the healthcare experience of family members of patients hospitalized during the pandemic period regarding safety and person- and family-centered care. Methods: Qualitative interpretative study, conducted through semi-structured interviews with six family members of people hospitalized during the pandemic period. Content analysis was performed using Atlas.ti software version 22 (Berlin, Germany) and Bardin’s methodology. Results and Conclusions: Restrictions on hospital visits due to the pandemic of COVID-19 have led to a distancing of families from the hospital setting and influenced healthcare practice, making it difficult to involve families in the care process. In some cases, healthcare professionals made efforts to provide PFCC, attempting to minimize the impact of the visitation restriction. However, there were reported experiences of care delivery that did not consider social and psychological factors and did not place the person and family at the center of the care process, relying instead on the biomedical model. These practices left out important factors for the provision of safe care. It is crucial, even in pandemic settings, that healthcare professionals provide person- and family-centered care to the extent possible, promoting the safety of care. The family should be involved in the care of the person in the inpatient setting.
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Affiliation(s)
- Tânia S. P. Correia
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), 4050-313 Porto, Portugal
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal
- Escola Superior de Saúde Ribeiro Sanches (ERISA)–IPLUSO, 1950-396 Lisboa, Portugal
- Correspondence:
| | - Maria Manuela F. P. S. Martins
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal
- Escola Superior de Enfermagem do Porto (ESEP), 4050-313 Porto, Portugal
| | | | - Olga Valentim
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal
- Escola Superior de Enfermagem de Lisboa (ESEL), 1600-096 Lisboa, Portugal
| | - César Fonseca
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - Manuel Lopes
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - Lara G. Pinho
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
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Mabunda NF, Mangena-Netshikweta ML, Lebese RT, Olaniyi FC. Family Perspectives Related to Caring for Mental Health Care Users: A Case Study in the Long-Term Mental Health Institutions of Limpopo Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10511. [PMID: 36078227 PMCID: PMC9518157 DOI: 10.3390/ijerph191710511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Family involvement in long-term mental health care is a significant therapeutic aspect in managing mentally ill patients. This study aimed to determine the perspectives of family members about caring for mental health care users at selected long-term mental health institutions in Limpopo Province. A qualitative explorative and contextual descriptive design was used. Purposive sampling was used to select family members with mental health care users admitted in long-term health institutions in Limpopo Province. Data were collected with in-depth individual interviews aided by an audio recorder and field notes. Data were qualitatively analysed. Trustworthiness and ethical considerations were ensured. Two themes yielded from the interviews: Perspectives of family members about their involvement in the care of mental health care users and difficulties in caring for mental health care users at home when granted leave of absence or discharged. Sub-themes: Caring for mental health care users leads to an understanding of mental illness; Lack of skill and inability to monitor mental health care users at home; Mental health care users abuse substances during leave of absence which makes family reluctant to request them for visit; Caring for mental health care users at home viewed as a difficult task and stigma from the community. The challenges experienced by family members contribute to poor interaction with mentally ill patients. We recommend that family members of mental health care users be educated about mental illnesses and encouraged to participate in the care of the patients.
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Affiliation(s)
- Nkhensani F. Mabunda
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | | | - Rachel T. Lebese
- Research Department, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Foluke C. Olaniyi
- Department of Public Health, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
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Correia TSP, Martins MMFPS, Barroso FF, Pinho LG, Fonseca C, Valentim O, Lopes M. The Implications of Family Members’ Absence from Hospital Visits during the COVID-19 Pandemic: Nurses’ Perceptions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158991. [PMID: 35897362 PMCID: PMC9330113 DOI: 10.3390/ijerph19158991] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/20/2022]
Abstract
Background: In response to the COVID-19 pandemic, several measures were taken to prevent the transmission of infection in the hospital environment, including the restriction of visits. Little is known about the consequences of these directives, but it is expected that they will have various implications. Thus, this study aimed to understand the consequences of measures to restrict visits to hospitalized individuals. Methods: A qualitative interpretive study was conducted through semistructured interviews with 10 nurses chosen by convenience. Content analysis was performed using Atlas.ti software, version 22 (Berlin, Germany). Results: Twenty-two categories and eight subcategories were identified and grouped according to their scope: implications for the patient, implications for the family, and implications for care practice. Conclusions: The identified categories of implications of restricting hospital visits (implications for patients, relatives, and care practices) are incomparably more negative than positive and have a strong potential to cause safety events in the short to long term, also jeopardizing the quality of care. There is the risk of stagnation and even setback due to this removal of families from the hospital environment, not only in terms of safety and quality of care but also with regard to person- and family-centered care.
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Affiliation(s)
- Tânia Sofia Pereira Correia
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), 4050-313 Porto, Portugal
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal; (M.M.F.P.S.M.); (O.V.)
- Escola Superior de Saúde Ribeiro Sanches (ERISA), Instituto Politécnico da Lusofonia(IPLUSO), 1950-396 Lisboa, Portugal
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal; (L.G.P.); (C.F.); (M.L.)
- Correspondence:
| | - Maria Manuela F. P. S. Martins
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal; (M.M.F.P.S.M.); (O.V.)
- Escola Superior de Enfermagem do Porto (ESEP), 4050-313 Porto, Portugal
| | | | - Lara G. Pinho
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal; (L.G.P.); (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - César Fonseca
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal; (L.G.P.); (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - Olga Valentim
- CINTESIS (Centro de Investigação em Tecnologias e Serviços de Saúde)—NursID (Innovation & Development in Nursing), 4050-313 Porto, Portugal; (M.M.F.P.S.M.); (O.V.)
- Escola Superior de Saúde Ribeiro Sanches (ERISA), Instituto Politécnico da Lusofonia(IPLUSO), 1950-396 Lisboa, Portugal
- Escola Superior de Saúde de Leiria (ESSLei), Instituto Politécnico de Leiria (IPLeiria), 2411-901 Leiria, Portugal
| | - Manuel Lopes
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal; (L.G.P.); (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
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Elma A, Cook D, Howard M, Takaoka A, Hoad N, Swinton M, Clarke F, Rudkowski J, Boyle A, Dennis B, Vegas DB, Vanstone M. Use of Video Technology in End-of-Life Care for Hospitalized Patients During the COVID-19 Pandemic. Am J Crit Care 2022; 31:240-248. [PMID: 35118491 DOI: 10.4037/ajcc2022722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Infection control protocols, including visitor restrictions, implemented during the COVID-19 pandemic threatened the ability to provide compassionate, family-centered care to patients dying in the hospital. In response, clinicians used videoconferencing technology to facilitate conversations between patients and their families. OBJECTIVES To understand clinicians' perspectives on using videoconferencing technology to adapt to pandemic policies when caring for dying patients. METHODS A qualitative descriptive study was conducted with 45 clinicians who provided end-of-life care to patients in 3 acute care units at an academically affiliated urban hospital in Canada during the first wave of the pandemic (March 2020-July 2020). A 3-step approach to conventional content analysis was used to code interview transcripts and construct overarching themes. RESULTS Clinicians used videoconferencing technology to try to bridge gaps in end-of-life care by facilitating connections with family. Many benefits ensued, but there were also some drawbacks. Despite the opportunity for connection offered by virtual visits, participants noted concerns about equitable access to videoconferencing technology and authenticity of technology-assisted interactions. Participants also offered recommendations for future use of videoconferencing technology both during and beyond the pandemic. CONCLUSIONS Clinician experiences can be used to inform policies and practices for using videoconferencing technology to provide high-quality end-of-life care in the future, including during public health crises.
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Affiliation(s)
- Asiana Elma
- Asiana Elma is a research assistant, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Deborah Cook
- Deborah Cook is a distinguished university professor, Department of Medicine, Division of Critical Care and Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, and a physician, Critical Care Program, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Michelle Howard
- Michelle Howard is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University
| | - Alyson Takaoka
- Alyson Takaoka was a research assistant, Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University
| | - Neala Hoad
- Neala Hoad is a registered nurse, Critical Care Program, St Joseph’s Healthcare Hamilton
| | - Marilyn Swinton
- Marilyn Swinton is a research coordinator, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University
| | - France Clarke
- France Clarke is a critical care research coordinator, Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University and a respiratory therapist, Critical Care Program, St Joseph’s Healthcare Hamilton
| | - Jill Rudkowski
- Jill Rudkowski is an associate professor, Division of Critical Care, Department of Medicine, Faculty of Health Sciences, McMaster University, and head of service, Intensive Care Unit and Medical Step-Down Unit, St Joseph’s Healthcare Hamilton
| | - Anne Boyle
- Anne Boyle is an associate clinical professor, Department of Family Medicine and a physician, Division of Palliative Care, St Joseph’s Healthcare Hamilton
| | - Brittany Dennis
- Brittany Dennis is an internal medicine resident, Department of Medicine, Division of Critical Care, Faculty of Health Sciences, McMaster University
| | - Daniel Brandt Vegas
- Daniel Brandt Vegas is an associate professor, Department of Medicine, Division of General Internal Medicine, Faculty of Health Sciences, McMaster University
| | - Meredith Vanstone
- Meredith Van-stone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University
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Goldfarb MJ, Bechtel C, Capers Q, de Velasco A, Dodson JA, Jackson JL, Kitko L, Piña IL, Rayner-Hartley E, Wenger NK, Gulati M. Engaging Families in Adult Cardiovascular Care: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025859. [PMID: 35446109 PMCID: PMC9238560 DOI: 10.1161/jaha.122.025859] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Family engagement empowers family members to become active partners in care delivery. Family members increasingly expect and wish to participate in care and be involved in the decision-making process. The goal of engaging families in care is to improve the care experience to achieve better outcomes for both patients and family members. There is emerging evidence that engaging family members in care improves person- and family-important outcomes. Engaging families in adult cardiovascular care involves a paradigm shift in the current organization and delivery of both acute and chronic cardiac care. Many cardiovascular health care professionals have limited awareness of the role and potential benefits of family engagement in care. Additionally, many fail to identify opportunities to engage family members. There is currently little guidance on family engagement in any aspect of cardiovascular care. The objective of this statement is to inform health care professionals and stakeholders about the importance of family engagement in cardiovascular care. This scientific statement will describe the rationale for engaging families in adult cardiovascular care, outline opportunities and challenges, highlight knowledge gaps, and provide suggestions to cardiovascular clinicians on how to integrate family members into the health care team.
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Heip T, Malfait S, Van Biesen W, Van Hecke A, Eeckloo K. Perceptions of interdisciplinary bedside rounds by head nurses in Flanders: a cross-sectional exploration. Acta Clin Belg 2022; 77:307-314. [PMID: 33287684 DOI: 10.1080/17843286.2020.1857612] [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] [Indexed: 10/22/2022]
Abstract
ObjectivesInterdisciplinary bedside rounds is gaining ground as a method to improve patient centredness and involvement, quality of care and team collaboration. An exploratory study was conducted in Flemish hospitals to (1) map and (2) examine the current form of rounds and the extent to which these were bedside, patient and family participatory and interdisciplinary.MethodsIn February 2020, a quantitative cross-sectional self-reporting web-based survey was conducted in 23 hospitals in Flanders, 213 head nurses of 213 wards completed the survey. A self-reporting 19-item questionnaire was developed in Lime Survey®. The questionnaire contained a mix of closed-ended questions an open-ended questions. The data were analysed using SPSS 26.0.ResultsMost of the wards in Flanders organise a form of daily rounds at the bedside. In only half of the wards these rounds are organised at a fixed time. The rounds most often include a physician and a nurse. Other disciplines are rarely actively involved. Only a minority of wards uses checklists, structures or protocols to standardise the rounds. The majority of the wards reports that patients (and family) get sufficient time to ask questions and say they are actively stimulated to do so.ConclusionIn current practice, most rounds are (partially) bedside, open for patient and family participatory and often include only a physician and a nurse. However, these elements of interdisciplinary rounds are not yet well integrated and vary strongly amongst ward. Most rounds should be considered as an extended form of physician rounds, rather than being interdisciplinary.
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Affiliation(s)
- Tine Heip
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Simon Malfait
- Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Kristof Eeckloo
- Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
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Golomski C. Visiting Hours: Spacetimes of Human-Animal Interaction in South African Elder Care. Med Anthropol Q 2022; 36:217-236. [PMID: 35338789 DOI: 10.1111/maq.12702] [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: 11/26/2022]
Abstract
This article examines human-animal interaction in elder care by focusing on an old age home in postapartheid South Africa. Residents admire and desire to be near animals, but staff mostly prohibit pets and service animals due to regulations about hygiene and frailty. Instead, people make meaningful relationships with media representations of animals and wilder animals in the home's yard. This article uses the clinical timescale of visiting hours to interpret these alternative human-animal interactions and their temporal incongruities-to show how people make sense of differences they perceive between their own and animals' mortality and longevity, and how animals enable remembering and articulations of aging selfhood and social relations across the life course. A reinterpretation of visiting hours reveals the making of self-other distinctions in late life and temporal aspects of medical institutionalism that shape multispecies relations.
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Moss SJ, Rosgen BK, Lucini F, Krewulak KD, Soo A, Doig CJ, Patten SB, Stelfox HT, Fiest KM. Psychiatric Outcomes in ICU Patients With Family Visitation: A Population-Based Retrospective Cohort Study. Chest 2022; 162:578-587. [PMID: 35271840 DOI: 10.1016/j.chest.2022.02.051] [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: 10/06/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Lack of family visitation in the ICU can have long-term consequences on patients in the ICU after discharge. The effect of family visitation on the incidence of patient psychiatric disorders is unknown. RESEARCH QUESTION What is the association between family visitation in the ICU and incidence of psychiatric outcomes in patients in the ICU 1 year after hospital discharge? STUDY DESIGN AND METHODS This study assessed a population-based retrospective cohort of adult patients admitted to the ICU from January 1, 2014, through May 30, 2017, surviving to hospital discharge with ICU length of stay of ≥ 3 days. To be eligible, patients needed to have minimum of 5 years of administrative data before ICU admission and a minimum of 1 year of follow-up data after hospital discharge. An internally validated algorithm that interpreted natural language in health records determined patients with or without in-person family (ie, relatives, friends) visitation during ICU stay. The primary outcome was risk of an incidence of psychiatric disorder (composite outcome), including anxiety, depressive, trauma- and stressor-related, psychotic, and substance use disorders, identified using coding algorithms for administrative databases. Propensity scores were used in inverse probability weighted logistic regression models, and average treatment effects were converted to risk ratios (RRs) with 95% CIs. Secondary outcomes were incidences of diagnoses by type of psychiatric disorder. RESULTS We included 14,344 patients with (96% [n = 13,771]) and without (4.0% [n = 573]) in-person family visitation who survived hospital discharge. More than one-third of patients received a diagnosis of any psychiatric disorder within 1 year after discharge (34.9%; 95% CI, 34.1%-35.6%). Patients most often received diagnoses of anxiety disorders (17.5%; 95% CI, 16.9%-18.1%) and depressive disorders (17.2%; 95% CI, 16.6%-17.9%). After inverse probability weighting of 13,731 patients, in-person family visitation was associated with a lower risk of received a diagnosis of any incident psychiatric disorder within 1 year after discharge (RR, 0.79; 95% CI, 0.68-0.92). INTERPRETATION ICU family visitation is associated with a decreased risk of psychiatric disorders in critically ill patients up to 1 year after hospital discharge.
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Affiliation(s)
- Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brianna K Rosgen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Filipe Lucini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Christopher J Doig
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Aerens S, Lepoudre S, Verstappen L, Vanhoucke AL, Malfait S, Van Humbeeck L. Family participation in the care of older hospitalised patients: Patients', family caregivers' and nurses' preferences on family caregivers performing care tasks. Int J Older People Nurs 2021; 17:e12440. [PMID: 34923742 DOI: 10.1111/opn.12440] [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: 04/13/2021] [Revised: 11/04/2021] [Accepted: 12/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND It is estimated that there are 101 million older care-dependent people (60+). This group is expected to double by 2050 due to the ageing of the world's population and the rise in life expectancy. Although people tend to live longer, there is little evidence that they live their later years in better health. In the future, this might put even more stress on an already overburdened acute care health system. Hospitals therefore need to focus on preventive measures to avoid rehospitalisation of older people. Family participation could be part of the solution. OBJECTIVES This study aimed to gain insight into the preferences of family caregivers, patients and nurses towards family caregivers taking up care tasks during hospitalisation, after receiving education. METHODS Data were collected using a cross-sectional survey of nursing staff, family caregivers and older patients in nine wards for older people within three hospitals. Data collection ran from October 2019 till March 2020 using a questionnaire of 25 care tasks with three answer options (perform alone, together with a nurse, do not perform). A consecutive sample of 330 patients and 133 family caregivers (81 dyads could be formed) next to a convenience sample of 67 nurses was obtained. RESULTS Patients (65%) are more prepared to let their family caregiver perform tasks alone than family caregivers (59%) and nurses (52%). Only few patients (3.8%) and family caregivers (13%) prefer the family caregiver to perform a task together with a nurse. The latter answer thus rather dichotomously, while nurses answer more dynamically over the three answer options. Of all family caregivers, 50% indicate willingness and ability to perform tasks on a regular basis. Significant correlations indicate that patients, family caregivers and nurses agree on which care tasks would be more preferable to be performed by a family caregiver. Looking at the dyads, preferences of a patient are not suspected to be more similar with his family caregiver than with a random family caregiver. CONCLUSIONS Patients, FCGs and nurses indicate to be prepared to engage in family participation. Further research needs to concentrate on the different attitudes and perceptions towards performing care tasks through qualitative research and how a successful implementation can be set up. IMPLICATIONS FOR PRACTICE Our study indicates that implementation of family participation in physical care within the hospital could be viable. TRIAL REGISTRATION The study protocol was approved by the ethical committee of the Ghent University Hospital (B670201940430).
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Affiliation(s)
- Sander Aerens
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Shani Lepoudre
- Department of Psychogeriatric Medicine, AZ Damiaan, Ostend, Belgium
| | | | | | - Simon Malfait
- Strategic unit and Nursing Department, Ghent University Hospital, Ghent, Belgium
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12
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Patient visitors in orthopaedic and trauma hospital wards: A balance of benefits and risks. Int J Orthop Trauma Nurs 2021; 44:100906. [PMID: 34686462 DOI: 10.1016/j.ijotn.2021.100906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Moss SJ, Krewulak KD, Stelfox HT, Ahmed SB, Anglin MC, Bagshaw SM, Burns KEA, Cook DJ, Doig CJ, Fox-Robichaud A, Fowler R, Hernández L, Kho ME, Kredentser M, Makuk K, Murthy S, Niven DJ, Olafson K, Parhar KKS, Patten SB, Rewa OG, Rochwerg B, Sept B, Soo A, Spence K, Spence S, Straus S, West A, Parsons Leigh J, Fiest KM. Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:347. [PMID: 34563234 PMCID: PMC8465762 DOI: 10.1186/s13054-021-03763-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 11/12/2022]
Abstract
Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals.
Methods We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. Results Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). Conclusions Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. Trial registration: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03763-7.
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Affiliation(s)
- Stephana J Moss
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Melanie C Anglin
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Hernández
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Maia Kredentser
- Department of Clinical Health Psychology, University of Manitoba, Manitoba, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kendiss Olafson
- Department of Medicine, University of Manitoba, Manitoba, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, Cuthbertson and Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Krista Spence
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean Spence
- Chinook Regional Hospital, Lethbridge County, Alberta, Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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14
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Dalkin SM, Hardwick RJL, Haighton CA, Finch TL. Combining Realist approaches and Normalization Process Theory to understand implementation: a systematic review. Implement Sci Commun 2021; 2:68. [PMID: 34174966 PMCID: PMC8234627 DOI: 10.1186/s43058-021-00172-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Realist approaches and Normalization Process Theory (NPT) have both gained significant traction in implementation research over the past 10 years. The aim of this study was therefore to explore how the approaches are combined to understand problems of implementation, to determine the degree of complementarity of the two approaches and to provide practical approaches for using them together. METHODS Systematic review of research studies combining Realist and NPT approaches. Realist methodology is concerned with understanding and explaining causation, that is, how and why policies, programmes and interventions achieve their effects. NPT is a theory of implementation that explains how practices become normalised. Databases searched (January 2020) were ASSIA, CINAHL, Health Research Premium Collection via Proquest (Family Health Database, Health & Medical Collection, Health Management Database, MEDLINE, Nursing & Allied Health Database, Psychology Database, Public Health Database) and PsycARTICLES. Studies were included if the author(s) stated they used both approaches: a scientific Realist perspective applying the principles of Pawson and Tilley's Realist Evaluation or Pawson's Realist Synthesis and Normalization Process Theory either solely or in addition to other theories. Two authors screened records; discrepancies were reviewed by a third screener. Data was extracted by three members of the team and a narrative synthesis was undertaken. RESULTS Of 245 total records identified, 223 unique records were screened and 39 full-text papers were reviewed, identifying twelve papers for inclusion in the review. These papers represented eight different studies. Extent and methods of integration of the approaches varied. In most studies (6/8), Realist approaches were the main driver. NPT was mostly used to enhance the explanatory power of Realist analyses, informing development of elements of Contexts, Mechanisms and Outcomes (a common heuristic in realist work). Authors' reflections on the integration of NPT and Realist approaches were limited. CONCLUSIONS Using Realist and NPT approaches in combination can add explanatory power for understanding the implementation of interventions and programmes. Attention to detailed reporting on methods and analytical process when combining approaches, and appraisal of theoretical and practical utility is advised for advancing knowledge of applying these approaches in research. SYSTEMATIC REVIEW REGISTRATION Not registered.
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Affiliation(s)
- Sonia Michelle Dalkin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle upon Tyne, UK
| | | | - Catherine A. Haighton
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Tracy L. Finch
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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15
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Huang LJ, Tsai HH, Wang YW, Chou CL. Sailing in a sea of perplexity: Family caregivers' experience of delirium patients. Nurs Crit Care 2021; 27:73-80. [PMID: 33890387 DOI: 10.1111/nicc.12620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/19/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Family caregivers play an important role for patients admitted to the intensive care unit (ICU), and delirium is a common clinical syndrome. Little is known about the experiences of family caregivers when a relative is a patient with delirium, especially for caregivers in Asian cultures. AIMS AND OBJECTIVE To understand the experience of family caregivers with a family member as a patient with delirium in the ICU in Taiwan. DESIGN A descriptive qualitative study with in-depth face-to-face semi-structured interviews. METHODS Interviews were conducted with 20 family caregivers of 20 patients with delirium in the ICU of a hospital in northern Taiwan. RESULTS The core theme describing the phenomenon of family caregivers of a patient with delirium was "Sailing in a sea of perplexity," which described family caregivers' uncertainty of navigating the ICU and providing support for a relative. Three subthemes described the core theme: (a) perplexity of the ICU environment, (b) perplexity of making decisions, and (c) perplexity of Chinese cultural constraints. CONCLUSION "Sailing in a sea of perplexity" underscores how uncertainty among family caregivers of patients with delirium in ICUs can lead to feelings of fear and anxiety. Therefore, nursing professionals should not only focus on patient care but also be sensitive to caregivers' feelings of uncertainty and their cultural beliefs. RELEVANCE TO CLINICAL PRACTICE Unfamiliarity and lack of knowledge about intensive care and patient treatments were a source of family caregivers' perplexity. To reduce uncertainty, we recommend increased communication between staff and caregivers. Hospitals can also provide information on their websites, including treatment of delirium and visitation hours. Information access could be enhanced by developing a smartphone app linked to a QR code that families can scan to obtain information, which would be useful during restricted visitation.
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Affiliation(s)
- Li-Jung Huang
- Department of Medical Intensive Care Unit, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Yi-Wen Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Liang Chou
- Department of Thoracic Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
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Munshi L, Evans G, Raza F. Pourquoi l’interdiction des visites dans les hôpitaux durant l’actuelle pandémie de COVID-19 devrait être assouplie. CMAJ 2021; 193:E505-E507. [PMID: 33824154 PMCID: PMC8049639 DOI: 10.1503/cmaj.202636-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Laveena Munshi
- Division interdépartementale de médecine des soins intensifs, Département de médecine (Munshi), Système de santé Sinaï et Réseau universitaire de santé, Université de Toronto; Institut de gestion, d'évaluation et de politiques de santé (Munshi, Razak), Université de Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division d'infectiologie, Département de médecine (Evans), Centre des sciences de la santé de Kingston, Université Queen's, Kingston, Ont.; Service de médecine (Razak), Hôpital St. Michael, Unity Health; Division de médecine interne générale, Département de médecine (Razak), Université de Toronto; Institut du savoir Li Ka Shing (Razak), Hôpital St. Michael, Toronto, Ont.
| | - Gerald Evans
- Division interdépartementale de médecine des soins intensifs, Département de médecine (Munshi), Système de santé Sinaï et Réseau universitaire de santé, Université de Toronto; Institut de gestion, d'évaluation et de politiques de santé (Munshi, Razak), Université de Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division d'infectiologie, Département de médecine (Evans), Centre des sciences de la santé de Kingston, Université Queen's, Kingston, Ont.; Service de médecine (Razak), Hôpital St. Michael, Unity Health; Division de médecine interne générale, Département de médecine (Razak), Université de Toronto; Institut du savoir Li Ka Shing (Razak), Hôpital St. Michael, Toronto, Ont
| | - Fahad Raza
- Division interdépartementale de médecine des soins intensifs, Département de médecine (Munshi), Système de santé Sinaï et Réseau universitaire de santé, Université de Toronto; Institut de gestion, d'évaluation et de politiques de santé (Munshi, Razak), Université de Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division d'infectiologie, Département de médecine (Evans), Centre des sciences de la santé de Kingston, Université Queen's, Kingston, Ont.; Service de médecine (Razak), Hôpital St. Michael, Unity Health; Division de médecine interne générale, Département de médecine (Razak), Université de Toronto; Institut du savoir Li Ka Shing (Razak), Hôpital St. Michael, Toronto, Ont
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17
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McKinney A, Fitzsimons D, Blackwood B, McGaughey J. Patient and family involvement in escalating concerns about clinical deterioration in acute adult wards: A qualitative systematic review. Nurs Crit Care 2020; 26:352-362. [PMID: 33345386 DOI: 10.1111/nicc.12582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite international standards for recognition and response to deterioration, warning signs are not always identified by staff on acute hospital wards. Patient and family-initiated escalation of care schemes have shown some benefit in assisting early recognition, but are not widely used in many clinical practice areas. OBJECTIVES To explore (a) patients' and relatives' experiences of acute deterioration and (b) patients', relatives' and healthcare professionals' perceptions of the barriers or facilitators to patient and family-initiated escalation of care in acute adult hospital wards. METHODS We conducted a qualitative review using Cochrane methodology. Two reviewers independently screened studies, extracted data, and appraised the quality using a qualitative critical appraisal tool. Findings were analysed using thematic synthesis and confidence in findings was assessed using GRADE-CERQual. SEARCH STRATEGY MEDLINE, CINAHL, EMBASE, PsychINFO databases and grey literature from 2005 to August 2019. INCLUSION CRITERIA Any research design that had a qualitative element and focused on adult patients' and relatives' experiences of deterioration and perceptions of escalating care. RESULTS We included five studies representing 120 participants and assessed the certainty of evidence as moderate using GRADE-CERQual. Findings indicated that a number of patients/relatives have the ability to detect acute deterioration, however, various factors act as both barriers and facilitators to being heard. These include personal factors, perceptions of role, quality of relationships with healthcare staff, and organisational factors. Theoretical understanding suggests that patient and relative involvement in escalation is dependent on both inherent capabilities and the factors that influence empowerment. CONCLUSION This review highlights that patient and family escalation of care interventions need to be designed with the aim of improving patient/relative-clinician collaboration and the sharing of responsibility. RELEVANCE TO PRACTICE These factors need to be addressed to promote more active partnerships when designing and implementing patient and family-initiated escalation of care interventions.
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Affiliation(s)
- Aidín McKinney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Jennifer McGaughey
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Munshi L, Evans G, Razak F. The case for relaxing no-visitor policies in hospitals during the ongoing COVID-19 pandemic. CMAJ 2020; 193:E135-E137. [PMID: 33355198 PMCID: PMC7954559 DOI: 10.1503/cmaj.202636] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Department of Medicine (Munshi), Sinai Health System and University Health Network, University of Toronto; Institute of Health Policy, Management and Evaluation (Munshi, Razak), University of Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division of Infectious Disease, Department of Medicine (Evans), Kingston Health Sciences Centre, Queen's University, Kingston, Ont.; Department of Medicine (Razak), St. Michael's Hospital, Unity Health; Division of General Internal Medicine, Department of Medicine (Razak), University of Toronto; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.
| | - Gerald Evans
- Interdepartmental Division of Critical Care Medicine, Department of Medicine (Munshi), Sinai Health System and University Health Network, University of Toronto; Institute of Health Policy, Management and Evaluation (Munshi, Razak), University of Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division of Infectious Disease, Department of Medicine (Evans), Kingston Health Sciences Centre, Queen's University, Kingston, Ont.; Department of Medicine (Razak), St. Michael's Hospital, Unity Health; Division of General Internal Medicine, Department of Medicine (Razak), University of Toronto; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont
| | - Fahad Razak
- Interdepartmental Division of Critical Care Medicine, Department of Medicine (Munshi), Sinai Health System and University Health Network, University of Toronto; Institute of Health Policy, Management and Evaluation (Munshi, Razak), University of Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division of Infectious Disease, Department of Medicine (Evans), Kingston Health Sciences Centre, Queen's University, Kingston, Ont.; Department of Medicine (Razak), St. Michael's Hospital, Unity Health; Division of General Internal Medicine, Department of Medicine (Razak), University of Toronto; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont
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