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Carenzo L, Costantini E, Cecconi M. Clinical governance in intensive care medicine. Intensive Care Med 2024:10.1007/s00134-024-07653-8. [PMID: 39316119 DOI: 10.1007/s00134-024-07653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024]
Affiliation(s)
- Luca Carenzo
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
| | - Elena Costantini
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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2
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Flannery E, Murphy G, Peters K, Halcomb E, Ramjan LM. Navigating the trauma-The experiences of significant others supporting patients with severe burn injury: A narrative inquiry. J Adv Nurs 2024. [PMID: 39180738 DOI: 10.1111/jan.16404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 07/26/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024]
Abstract
AIM To explore the experiences of significant others of adult patients with severe burn injury in the Intensive Care Unit. Specifically, this study explored the strategies implemented by significant others and obstacles faced that served to protect or placed them at risk of psychological sequelae during their experience of trauma. DESIGN A qualitative study using a Narrative Inquiry approach was undertaken. METHODS Individual semi-structured interviews were conducted with 17 participants during 2021-2022, who were a significant other of an adult patient in ICU with severe burn injury. These participants were recruited from the two major severe burns receiving hospitals in New South Wales, Australia. Participants' stories were analysed using a narrative analysis approach informed by Polkinghorne. The COREQ guideline was used in reporting. RESULTS As each participant navigated the traumatic experience of supporting a loved one with a severe burn injury, they faced unique obstacles to maintaining their own mental health and well-being. They employed strategies that were likely to protect them on this journey. Psychologically protective factors included taking back control, coexisting in the trauma with the patient and forging a trauma bond. These strategies effectively contained the trauma and protected others (such as children, extended family and friends). While this allowed significant others an element of control, it also effectively isolated them from the support of family and friends. CONCLUSION This study shows that significant others may also experience personal trauma and may not recognize this as they focus all their attention on supporting the patient with the burn injury. IMPLICATIONS FOR PRACTICE With increased awareness of both protective and risk factors, support can be directed towards enhancing protective factors and addressing risk factors, thereby decreasing their impact and improving support for significant others. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Elizabeth Flannery
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Gillian Murphy
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lucie M Ramjan
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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3
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Frelinger JM, Tan JM, Klein MJ, Newth CJL, Ross PA, Winter MC. Factors associated with family decision-making after pediatric out-of-hospital cardiac arrest. Resuscitation 2024; 201:110233. [PMID: 38719070 DOI: 10.1016/j.resuscitation.2024.110233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 08/07/2024]
Abstract
AIM This study aims to identify demographic factors, area-based social determinants of health (SDOH), and clinical features associated with medical decision-making after pediatric out-of-hospital cardiac arrest (OHCA). METHODS This is a retrospective, exploratory, descriptive analysis of patients < 18 years old admitted to the pediatric intensive care unit (ICU) after OHCA from 2011 to 2022 (n = 217) at an urban tertiary care, free-standing children's hospital. Outcomes of interest included: (1) whether a new advance care plan (ACP) (defined as a written advance directive including do not resuscitate and/or do not intubate) was ordered during hospitalization, and (2) whether the patient was discharged with new medical technology (defined as tracheostomy and/or feeding tube). Logistic regression models identified features associated with these outcomes. RESULTS Of the 217 patients, 78 patients (36%) had a new ACP placed during their admission. Of the survivors, 26% (27/102) were discharged home with new medical technology. Factors associated with ACP were greater change in Pediatric Cerebral Performance Category (PCPC) score (aOR = 1.49, 95% CI [1.28-1.73], p-value < 0.001) and palliative care consultation (aOR = 2.39, 95% CI [1.16-4.89], p-value 0.018). Factors associated with new medical technology were lower change in PCPC score (aOR = 0.76, 95% C.I. [0.61-0.95], p-value = 0.015) and palliative care consultation (aOR = 7.07, 95% CI [3.01-16.60], p-value < 0.001). There were no associations between area-based SDOH and outcomes. CONCLUSIONS Understanding factors associated with decision-making related to ACP after OHCA is critical to optimize counseling for families. Multi-institutional studies are warranted to identify whether these findings are generalizable.
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Affiliation(s)
- Jessica M Frelinger
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA.
| | - Jonathan M Tan
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Spatial Sciences Institute, University of Southern California, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA 90089, USA; Department of Anesthesiology, University of Southern California Keck School of Medicine, 1520 San Pablo St., Los Angeles, CA 90033, USA
| | - Margaret J Klein
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA
| | - Christopher J L Newth
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Patrick A Ross
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Meredith C Winter
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA 90033, USA
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Trotta F, Petrosino F, Pucciarelli G, Alvaro R, Vellone E, Bartoli D. Reliability and validity of the training satisfaction questionnaire for family members (TSQ-FM) entering the ICU during an isolation disease outbreak. Heart Lung 2024; 66:37-45. [PMID: 38574598 DOI: 10.1016/j.hrtlng.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The presence of family members in an isolated ICU during an isolation disease outbreak is restricted by hospital policies because of the infectious risk. This can be overcome by conferring to family members the skill and the ability to safely don and doff the personal protective equipment (PPE) through a nurse-led training intervention and assess their satisfaction, to respond to the need to define a safe, effective and quality care pathway focused on Family-Centered Care (FCC) principles. OBJECTIVE the study aimed to build a valid and reliable instrument for clinical practice to assess family members' satisfaction to allow ICU nurses to restore family integrity in any case of infectious disease outbreak that requires isolation. METHODS A cross-sectional study was conducted to test the psychometric properties. The questionnaire was constructed based on a literature review on the needs of family members in the ICU. 76 family members were admitted to a COVID-ICU. Cronbach's coefficient, Geomin rotated loading, and EFA were applied to assess the reliability and validity of the instrument. RESULTS The Kaiser-Mayer-Olkin (KMO) measure was 0.662, the Bartlett sphericity test showed a significant p-value (χ²=448.33; df=45; p < 0.01), Cronbach's alpha coefficient was.896. A further CFA analysis confirmed that all fit indices were acceptable. The results showed satisfactory validity and reliability, which could be generalized and extended to any outbreak of isolation disease. CONCLUSIONS This study provides a valid and reliable instrument for clinical practice to maintain family integrity in the dyadic relationship between the patient and the family member, even during an emergency infectious disease outbreak that requires isolation.
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Affiliation(s)
- Francesca Trotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Francesco Petrosino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Bartoli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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5
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Azoulay É, Kentish-Barnes N, Boulanger C, Mistraletti G, van Mol M, Heras-La Calle G, Estenssoro E, van Heerden PV, Delgado MCM, Perner A, Arabi YM, Myatra SN, Laake JH, De Waele JJ, Darmon M, Cecconi M. Family centeredness of care: a cross-sectional study in intensive care units part of the European society of intensive care medicine. Ann Intensive Care 2024; 14:77. [PMID: 38771395 PMCID: PMC11109056 DOI: 10.1186/s13613-024-01307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/05/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE To identify key components and variations in family-centered care practices. METHODS A cross-sectional study, conducted across ESICM members. Participating ICUs completed a questionnaire covering general ICU characteristics, visitation policies, team-family interactions, and end-of-life decision-making. The primary outcome, self-rated family-centeredness, was assessed using a visual analog scale. Additionally, respondents completed the Maslach Burnout Inventory and the Ethical Decision Making Climate Questionnaire to capture burnout dimensions and assess the ethical decision-making climate. RESULTS The response rate was 53% (respondents from 359/683 invited ICUs who actually open the email); participating healthcare professionals (HCPs) were from Europe (62%), Asia (9%), South America (6%), North America (5%), Middle East (4%), and Australia/New Zealand (4%). The importance of family-centeredness was ranked high, median 7 (IQR 6-8) of 10 on VAS. Significant differences were observed across quartiles of family centeredness, including in visitation policies availability of a waiting rooms, family rooms, family information leaflet, visiting hours, night visits, sleep in the ICU, and in team-family interactions, including daily information, routine day-3 conference, and willingness to empower nurses and relatives. Higher family centeredness correlated with family involvement in rounds, participation in patient care and end-of-life practices. Burnout symptoms (41% of respondents) were negatively associated with family-centeredness. Ethical climate and willingness to empower nurses were independent predictors of family centeredness. CONCLUSIONS This study emphasizes the need to prioritize healthcare providers' mental health for enhanced family-centered care. Further research is warranted to assess the impact of improving the ethical climate on family-centeredness.
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Affiliation(s)
- Élie Azoulay
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris-Cité University, 1 avenue Claude Vellefaux, Paris, 75010, France.
| | - Nancy Kentish-Barnes
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris-Cité University, 1 avenue Claude Vellefaux, Paris, 75010, France
| | - Carole Boulanger
- Royal Devon University NHS Foundation Trust, Barrack Road, Exeter, UK
| | - Giovanni Mistraletti
- Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti. A.S.S.T. Ovest Milanese, Università degli Studi di Milano, Ospedale Civile di Legnano, Legnano, MI, Italy
| | | | - Gabriel Heras-La Calle
- International Research Project for the Humanisation of Intensive Care Units, Proyecto HU-CI, Madrid, Spain
- Humanizing Healthcare Foundation. Intensive Care Unit, Hospital Universitario de Jaén, Jaén, Spain
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos General San Martín, La Plata, Buenos Aires, Argentina
| | - Peter Vernon van Heerden
- Department of Anesthesiology, Critical Care and Pain medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maria-Cruz Martin Delgado
- Department Intensive Care Medicine Hospital 12 de Octubre, Madrid, Spain
- Research Institute "Hospital 12 de Octubre (imas12)", Universidad Complutense de Madrid, Madrid, Spain
| | - Anders Perner
- Department of Intensive Care, Department of Clinical Medicine, Copenhagen University Hospital - Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Yaseen M Arabi
- Intensive Care Department, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Ministry of National Guard Health - Affairs, and College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Mumbai, India
| | - Jon Henrik Laake
- Department of Anaesthesiology and Intensive Care Medicine, Division of Critical Care and Emergencies, Rikshopitalet Medical Centre, Oslo University Hospital, Oslo, Norway
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Gent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Michael Darmon
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris-Cité University, 1 avenue Claude Vellefaux, Paris, 75010, France
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Levi Montalcini, Pieve Emanuele, MI, Italy
- 2IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
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Saputra R, Setyorini, Rasmanah M, Nuraida, Suryati, Lidyawati Y. Strengthening family bonds through end-of-life conversations: Understanding the importance of emotional support and open communication. Palliat Support Care 2024:1-2. [PMID: 38419207 DOI: 10.1017/s1478951524000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Rikas Saputra
- Department of Islamic Guidance and Counselling, Faculty of Da'wah and Communication, Universitas Islam Negeri Raden Fatah Palembang, South Sumatra, Indonesia
| | - Setyorini
- Department of Guidance and Counselling, Faculty of Teacher Training and Education Satya Wacana University, Salatiga, Indonesia
| | - Manah Rasmanah
- Department of Islamic Guidance and Counselling, Faculty of Da'wah and Communication, Universitas Islam Negeri Raden Fatah Palembang, South Sumatra, Indonesia
| | - Nuraida
- Department of Islamic Guidance and Counselling, Faculty of Da'wah and Communication, Universitas Islam Negeri Raden Fatah Palembang, South Sumatra, Indonesia
| | - Suryati
- Department of Islamic Guidance and Counselling, Faculty of Da'wah and Communication, Universitas Islam Negeri Raden Fatah Palembang, South Sumatra, Indonesia
| | - Yenni Lidyawati
- Department of Indonesian Language and Literature, Faculty of Teacher Training and Education, Sriwijaya University, Palembang, Indonesia
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Georgakis S, Dragioti E, Gouva M, Papathanakos G, Koulouras V. The Complex Dynamics of Decision-Making at the End of Life in the Intensive Care Unit: A Systematic Review of Stakeholders' Views and Influential Factors. Cureus 2024; 16:e52912. [PMID: 38406151 PMCID: PMC10893775 DOI: 10.7759/cureus.52912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
A lack of consensus resulting in severe conflicts is often observed between the stakeholders regarding their respective roles in end-of-life (EOL) decision-making in the ICU. Since the burden of these decisions lies upon the individuals, their opinions must be known by medical, judicial, legislative, and governmental authorities. Part of the solution to the issues that arise would be to examine and understand the views of the people in different societies. Hence, in this systematic review, we assessed the attitudes of the physicians, nurses, families, and the general public toward who should be involved in decision-making and influencing factors. Toward this, we searched three electronic databases, i.e., PubMed, CINAHL (Cumulative Index to Nursing & Allied Health), and Embase. A matrix was developed, discussed, accepted, and used for data extraction by two independent investigators. Study quality was evaluated using the Newcastle-Ottawa Scale. Data were extracted by one researcher and double-checked by a second one, and any discrepancies were discussed with a third researcher. The data were analyzed descriptively and synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirty-three studies met our inclusion criteria. Most involved healthcare professionals and reported geographic variations in different timeframes. While paternalistic features have been observed, physicians overall showed an inclination toward collaborative decision-making. Correspondingly, the nursing staff, families, and the public are aligned toward patient and relatives' participation, with nurses expressing their own involvement as well. Six categories of influencing factors were identified, with high-impact factors, including demographics, fear of litigation, and regulation-related ones. Findings delineate three key points. Firstly, overall stakeholders' perspectives toward EOL decision-making in the ICU seem to be leaning toward a more collaborative decision-making direction. Secondly, to reduce conflicts and reach a consensus, multifaceted efforts are needed by both healthcare professionals and governmental/regulatory authorities. Finally, due to the multifactorial complexity of the subject, directly related to demographic and regulatory factors, these efforts should be more extensively sought at a regional level.
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Affiliation(s)
- Spiros Georgakis
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, University of Ioannina, Ioannina, GRC
| | - Mary Gouva
- Research Laboratory Psychology of Patients, Families & Health Professionals, University of Ioannina, Ioannina, GRC
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Momiyama S, Kakeya K, Dannoue H, Yanagi H. A Survey of Emergency Nurses' Perceptions and Practices to Support Patients' Families as Surrogate Decision Makers. J Emerg Nurs 2023; 49:899-911. [PMID: 37690019 DOI: 10.1016/j.jen.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 06/21/2023] [Accepted: 08/01/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Family members acting as surrogate decision makers for severely ill patients in emergency and critical care centers face psychological burdens. This study aimed to investigate the actual situation of emergency nurses' perceptions and practices to support patients' families and its structural elements. METHODS We created an original 25-item questionnaire and surveyed 164 emergency nurses from 64 emergency and critical care centers regarding their perceptions of caring for people making surrogate decisions. Participants averaged 35.6 years old and 5.1 years as emergency nurses. RESULTS Cronbach's α coefficients for importance and practice on the original questionnaire were 0.936 and 0.933, respectively. We identified 4 elements of necessary support for patient families making surrogate decisions according to emergency nurses: "collaboration in understanding the condition of the patient as well as empathetic support," "care that addresses the needs of patient's family members," "confirming the role of nurses and surrogate decision making," and "participation in meeting with a doctor and patient families." In addition, we identified 5 elements that indicate the current state of practice: "support from specialists such as nurses and other professionals," "compassionate care for family members and those who are providing support to family members," "empathetic support for family members," "support for making arrangements that address the needs of family members," and "considerations for family members." DISCUSSION According to the findings of this study, emergency nurses should coordinate with other professionals and talk with family members and physicians to increase their understanding of the need to assist in surrogate decision making. In addition, emergency nurses also need to explain to patients' relatives how to support them in surrogate decision making.
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Vinarski-Peretz H, Mashiach-Eizenberg M, Idilbi N, Halperin D. Service Climate and Nurses' Collaboration with Families of Older Patients in the Care Process during Hospitalization. Healthcare (Basel) 2023; 11:2485. [PMID: 37761682 PMCID: PMC10531144 DOI: 10.3390/healthcare11182485] [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: 08/21/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
This study focuses on the concrete role of the presence of a ward's service climate in cultivating nurses' collaboration with family members. Accordingly, this study examined the moderating role of the service climate in the link between nurses' attitudes toward the family and their collaboration with family members in the care process. This is the second article of a series of studies we conducted among health staff in Israeli public hospitals. Relying on the patient- and family-centered care approach and using a cross-sectional study of 179 nurses from 13 internal medicine, surgical and geriatric wards at a large public hospital in Israel, we conducted a multiple regression analysis to test the contribution of all relationship variables to predicting nurses' collaborative behavior with the family in the care process during elderly hospitalization. The findings indicate that service climate had a conditional moderating effect on the relationship between nurses' perception of the family as a burden and their collaboration with the family in nursing care. Namely, in the absence of a targeted service climate, nurses form perceptions about the families as a burden, which in turn affects their distinct non-collaboration, and vice versa.
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Affiliation(s)
- Hedva Vinarski-Peretz
- M.A. Program in Public Administration and Public Policy, Department of Political Science, Yezreel Valley Academic College, Yezreel Valley 1930600, Israel
- Department of Health Systems Management, Yezreel Valley Academic College, Yezreel Valley 1930600, Israel; (M.M.-E.); (D.H.)
| | - Michal Mashiach-Eizenberg
- Department of Health Systems Management, Yezreel Valley Academic College, Yezreel Valley 1930600, Israel; (M.M.-E.); (D.H.)
| | - Nasra Idilbi
- Department of Nursing, Yezreel Valley Academic College, Yezreel Valley 1930600, Israel;
- Nursing Research Unit, Galilee Medical Center, Nahariya 22100, Israel
| | - Dafna Halperin
- Department of Health Systems Management, Yezreel Valley Academic College, Yezreel Valley 1930600, Israel; (M.M.-E.); (D.H.)
- Department of Community Gerontology, Yezreel Valley Academic College, Yezreel Valley 1930600, Israel
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Mazzu MA, Campbell ML, Schwartzstein RM, White DB, Mitchell SL, Fehnel CR. Evidence Guiding Withdrawal of Mechanical Ventilation at the End of Life: A Review. J Pain Symptom Manage 2023; 66:e399-e426. [PMID: 37244527 PMCID: PMC10527530 DOI: 10.1016/j.jpainsymman.2023.05.009] [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: 03/08/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Distress at the end of life in the intensive care unit (ICU) is common. We reviewed the evidence guiding symptom assessment, withdrawal of mechanical ventilation (WMV) process, support for the ICU team, and symptom management among adults, and specifically older adults, at end of life in the ICU. SETTING AND DESIGN Systematic search of published literature (January 1990-December 2021) pertaining to WMV at end of life among adults in the ICU setting using PubMed, Embase, and Web of Science. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. PARTICIPANTS Adults (age 18 and over) undergoing WMV in the ICU. MEASUREMENTS Study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS Out of 574 articles screened, 130 underwent full text review, and 74 were reviewed and assessed for quality. The highest quality studies pertained to use of validated symptom scales during WMV. Studies of the WMV process itself were generally lower quality. Support for the ICU team best occurs via structured communication and social supports. Dyspnea is the most distressing symptom, and while high quality evidence supports the use of opiates, there is limited evidence to guide implementation of their use for specific patients. CONCLUSION High quality studies support some practices in palliative WMV, while gaps in evidence remain for the WMV process, supporting the ICU team, and medical management of distress. Future studies should rigorously compare WMV processes and symptom management to reduce distress at end of life.
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Affiliation(s)
- Maria A Mazzu
- University of New England College of Osteopathic Medicine (M.A.M.), Biddeford, Maine, USA
| | | | - Richard M Schwartzstein
- Beth Israel Deaconess Medical Center (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Harvard Medical School (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA
| | - Douglas B White
- University of Pittsburgh School of Medicine (D.B.W.), Pittsburgh, Pennsylvania, USA
| | - Susan L Mitchell
- Beth Israel Deaconess Medical Center (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Harvard Medical School (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Hebrew SeniorLife, Marcus Institute for Aging Research (S.L.M., C.R.F.), Boston, Massachusetts, USA
| | - Corey R Fehnel
- Beth Israel Deaconess Medical Center (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Harvard Medical School (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Hebrew SeniorLife, Marcus Institute for Aging Research (S.L.M., C.R.F.), Boston, Massachusetts, USA.
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11
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Carroll E, Giles J, Lewis A. An evaluation of surrogate decision maker health literacy in the neurology ward and neuroscience ICU. J Neurol Sci 2023; 444:120525. [PMID: 36525907 DOI: 10.1016/j.jns.2022.120525] [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: 07/11/2022] [Revised: 11/14/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE There has been little investigation into surrogate comprehension of education provided by the neuroscience healthcare team. We sought to evaluate 1) surrogate understanding about a patient's clinical condition and 2) the relationship between how surrogates and the neuroscience team perceive surrogate comprehension of a patient's condition. METHODS We prospectively surveyed surrogates of patients who lacked decision making capacity while admitted to the neurology ward or neuroscience ICU for >48 h from 10/2018-05/2021. The survey investigated the surrogate's communication with the neuroscience team and understanding of the hospitalization. A member of the neuroscience team was asked to provide clinical data about the patient and indicate how well they perceived the surrogate understood the situation. RESULTS We surveyed 50 surrogates at a median of 10 (IQR 5-17) days after hospitalization. There were 38 (76%) surrogates who correctly identified the reason for admission, and 21 (42%) who correctly identified all the assessments/interventions performed. Nearly all surrogates rated their understanding of the patient's medical condition as excellent (47%) or good (49%). There was no to slight agreement (kappa = 0.133) between surrogate self-perception of understanding and neuroscience team perception of the surrogate's understanding. Although only 20% of surrogates used institutional electronic education materials, 74% discussed the hospitalization with friends/family who work in healthcare. CONCLUSION Objective and subjective assessments of surrogate comprehension demonstrate that there is a need to improve communication with the surrogates of patients with neurological conditions. Neuroscience healthcare teams must be taught how to educate surrogates and assess their understanding.
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Affiliation(s)
- Elizabeth Carroll
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States of America.
| | - Julie Giles
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States of America
| | - Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States of America; Department of Neurosurgery, NYU Langone Medical Center, New York, NY, United States of America
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12
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Giabicani M, Arditty L, Mamzer MF, Fournel I, Ecarnot F, Meunier-Beillard N, Bruneel F, Weiss E, Spranzi M, Rigaud JP, Quenot JP. Team-family conflicts over end-of-life decisions in ICU: A survey of French physicians' beliefs. PLoS One 2023; 18:e0284756. [PMID: 37098023 PMCID: PMC10128920 DOI: 10.1371/journal.pone.0284756] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/08/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Conflicts between relatives and physicians may arise when decisions are being made about limiting life-sustaining therapies (LST). The aim of this study was to describe the motives for, and management of team-family conflicts surrounding LST limitation decisions in French adult ICUs. METHODS Between June and October 2021, French ICU physicians were invited to answer a questionnaire. The development of the questionnaire followed a validated methodology with the collaboration of consultants in clinical ethics, a sociologist, a statistician and ICU clinicians. RESULTS Among 186 physicians contacted, 160 (86%) answered all the questions. Conflicts over LST limitation decisions were mainly related to requests by relatives to continue treatments considered to be unreasonably obstinate by ICU physicians. The absence of advance directives, a lack of communication, a multitude of relatives, and religious or cultural issues were frequently mentioned as factors contributing to conflicts. Iterative interviews with relatives and proposal of psychological support were the most widely used tools in attempting to resolve conflict, while the intervention of a palliative care team, a local ethics resource or the hospital mediator were rarely solicited. In most cases, the decision was suspended at least temporarily. Possible consequences include stress and psychological exhaustion among caregivers. Improving communication and anticipation by knowing the patient's wishes would help avoid these conflicts. CONCLUSION Team-family conflicts during LST limitation decisions are mainly related to requests from relatives to continue treatments deemed unreasonable by physicians. Reflection on the role of relatives in the decision-making process seems essential for the future.
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Affiliation(s)
- Mikhael Giabicani
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, and Université Paris Cité, Paris, France
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm, Laboratoire ETREs, Paris, France
| | - Laure Arditty
- Service de Réanimation, Centre Hospitalier Intercommunal des Alpes du Sud, Gap, France
| | - Marie-France Mamzer
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm, Laboratoire ETREs, Paris, France
- Unité Fonctionnelle d'Ethique Médicale, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Isabelle Fournel
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, Besançon, France
- EA3920, Université de Bourgogne-Franche Comté, Besançon, France
| | - Nicolas Meunier-Beillard
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | - Fabrice Bruneel
- Intensive Care Unit, Versailles Hospital Center, Le Chesnay, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, and Université Paris Cité, Paris, France
| | - Marta Spranzi
- Center for Clinical Ethics, AP-HP, Paris and Université de Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, CH de Dieppe, Dieppe, France
- Espace de Réflexion Éthique de Normandie, CHU de Caen, Caen, France
| | - Jean-Pierre Quenot
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
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13
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Madrigal VN, Feltman DM, Leuthner SR, Kirsch R, Hamilton R, Dokken D, Needle J, Boss R, Lelkes E, Carter B, Macias E, Bhombal S. Bioethics for Neonatal Cardiac Care. Pediatrics 2022; 150:189885. [PMID: 36317974 DOI: 10.1542/peds.2022-056415n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Clinicians caring for neonates with congenital heart disease encounter challenges with ethical implications in daily practice and must have some basic fluency in ethical principles and practical applications. METHODS Good ethical practice begins with a thorough understanding of the details and narrative of each individual case, examination via classic principles of bioethics, and further framing of that translation into practice. RESULTS We explore some of these issues and expand awareness through the lens of a case presentation beginning with fetal considerations through end-of-life discussions. CONCLUSIONS We include specific sections that bring attention to shared decision-making, research ethics, and outcomes reporting. We review empirical evidence and highlight recommendations.
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Affiliation(s)
- Vanessa N Madrigal
- Department of Pediatrics, Division of Critical Care Medicine and Pediatric Ethics Program, Children's National Hospital, George Washington University, Washington, District of Columbia
| | - Dalia M Feltman
- NorthShore University HealthSystem Evanston Hospital, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Steven R Leuthner
- Departments of Pediatrics and Bioethics, Division of Neonatology, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Roxanne Kirsch
- Department of Critical Care, Division Cardiac Critical Care Medicine; Department of Bioethics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rekha Hamilton
- Mednax Inc. Cook Children's Medical Center, Fort Worth, Texas
| | - Deborah Dokken
- Family Leader and Staff Member, Institute for Patient and Family-Centered Care, Bethesda, Maryland
| | - Jennifer Needle
- Department of Pediatrics and the Center for Bioethics, University of Minnesota, Minneapolis, Minnesota
| | - Renee Boss
- Department of Pediatrics, Johns Hopkins School of Medicine and Berman Institute of Bioethics, Baltimore, Maryland
| | - Efrat Lelkes
- Department of Pediatrics, Divisions of Critical Care Medicine and Palliative Medicine, Bioethics, University of California San Francisco, San Francisco, California
| | - Brian Carter
- Departments of Humanities and Pediatrics, Division of Neonatology and Bioethics Center, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Eduardo Macias
- Department of Pediatrics, Division of Pediatric Cardiology. University Hospital, University of Texas, San Antonio, Texas
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital. Stanford, Palo Alto, California
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14
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Interdisziplinäre und interprofessionelle Kommunikation im Team. Med Klin Intensivmed Notfmed 2022; 117:588-594. [DOI: 10.1007/s00063-022-00955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
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15
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Riegel M, Randall S, Buckley T. Factors associated with the decision to offer memory making in end-of-life: A survey of healthcare professionals in adult intensive care. J Clin Nurs 2022; 32:2627-2641. [PMID: 35415864 DOI: 10.1111/jocn.16323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
AIM Report experiences and behaviour influences with healthcare professionals' decision to and experiences of offering memory making during end-of-life care in the adult acute population. BACKGROUND Little is known about healthcare professionals' experiences offering memory making during adult acute end-of-life care. DESIGN Survey. METHODS Registered nurses, medical practitioners and social workers employed at a single tertiary referral adult intensive care, where memory making had been implemented nearly two years prior were invited to participate between June and August 2017. Reporting adheres to the STROBE checklist. RESULTS Ninety-six valid surveys (75% response rate: 75 registered nurses, 19 medical practitioners, and 2 social workers) were analysed with 67 participants reporting experience offering memory making. Highest overall agreement scores included believing families value memory making and the offer of memory making being beneficial. Enablers were described as organisational supports, personal qualities and good interpersonal relationships. Barriers identified included the intensive care environment, workload, inexperience offering/facilitating memory making, being afraid to offer, lack of resources and legality concerns. Compared with non-experienced participants, experienced participants reported higher level of confidence and comfort offering memory making, pride in their ability, ability to spend time supporting families and had observed colleagues offering memory making. Experienced participants were less likely to be afraid to offer, be limited by the family's behaviours, report lack of resources or be time limited to offer memory making. CONCLUSION Findings identify elements needed for the development and support for offering memory making to assist bereaved families in adult acute care including role modelling, support to reduce negative emotions, workload assistance and leadership/organisational support. RELEVANCE TO CLINICAL PRACTICE Discoveries have important implications in addressing evidence gaps regarding behaviour influences linked to the decision to offer memory making. Findings inform development and sustainability to integrate memory making as routine end-of-life care intervention in adult acute care.
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Affiliation(s)
- Melissa Riegel
- Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Sue Randall
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Thomas Buckley
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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16
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Drury A, Muscat DM, Wibrow B, Jacques A, Anstey M. Integrating the Choosing Wisely 5 Questions into Family Meetings in the Intensive Care Unit: A Randomized Controlled Trial Investigating the Effect on Family Perceived Involvement in Decision-Making. J Patient Exp 2022; 9:23743735221092623. [PMID: 35434292 PMCID: PMC9006367 DOI: 10.1177/23743735221092623] [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] [Indexed: 11/17/2022] Open
Abstract
Family members often act as surrogate decision makers for patients in the intensive care unit (ICU). The use of printed prompts may assist with families feeling empowered to fulfill this role. Prospective, randomized controlled trial in 3 ICUs in Western Australia. In the intervention arm, families received the Choosing Wisely 5 questions as printed prompts prior to a family meeting, and the control arm did not receive prompts. The primary outcome was family perceived involvement in decision-making. Outcomes were measured using a survey. Sixty families participated in the study. The majority of families (87.1% control, 79.3% intervention; P = .334) reported feeling “very included” in decision-making. There was no difference in secondary outcomes, including minimal uptake of the questions by the intervention arm. This has been the first randomized trial evaluating the use of a decision-making tool for families in the ICU. Despite ceiling effects in outcome measures, these results suggest room for future study of the Choosing Wisely 5 questions in the ICU.
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Affiliation(s)
- Ashleigh Drury
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
| | - Bradley Wibrow
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Matthew Anstey
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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17
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Fagundes A, Berg DD, Bohula EA, Baird-Zars VM, Barnett CF, Carnicelli AP, Chaudhry SP, Guo J, Keeley EC, Kenigsberg BB, Menon V, Miller PE, Newby LK, van Diepen S, Morrow DA, Katz JN. End-of-life care in the cardiac intensive care unit: a contemporary view from the Critical Care Cardiology Trials Network (CCCTN) Registry. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:190-197. [PMID: 34986236 DOI: 10.1093/ehjacc/zuab121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
AIMS Increases in life expectancy, comorbidities, and survival with complex cardiovascular conditions have changed the clinical profile of the patients in cardiac intensive care units (CICUs). In this environment, palliative care (PC) services are increasingly important. However, scarce information is available about the delivery of PC in CICUs. METHODS AND RESULTS The Critical Care Cardiology Trials Network (CCCTN) Registry is a network of tertiary care CICUs in North America. Between 2017 and 2020, up to 26 centres contributed an annual 2-month snapshot of all consecutive medical CICU admissions. We captured code status at admission and the decision for comfort measures only (CMO) before all deaths in the CICU. Of 13 422 patients, 10% died in the CICU and 2.6% were discharged to palliative hospice. Of patients who died in the CICU, 68% were CMO at death. In the CMO group, only 13% were do not resuscitate/do not intubate at admission. The median time from CICU admission to CMO decision was 3.4 days (25th-75th percentiles: 1.2-7.7) and ≥7 days in 27%. Time from CMO decision to death was <24 h in 88%, with a median of 3.8 h (25th-75th 1.0-10.3). Before a CMO decision, 78% received mechanical ventilation and 26% mechanical circulatory support. A PC provider team participated in the care of 41% of patients who died. CONCLUSIONS In a contemporary CICU registry, comfort measures preceded death in two-thirds of cases, frequently without PC involvement. The high utilization of advanced intensive care unit therapies and lengthy times to a CMO decision highlight a potential opportunity for early engagement of PC teams in CICU.
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Affiliation(s)
- Antonio Fagundes
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - David D Berg
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Erin A Bohula
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Vivian M Baird-Zars
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Christopher F Barnett
- Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, Washington, DC, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Anthony P Carnicelli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Jianping Guo
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Ellen C Keeley
- Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Benjamin B Kenigsberg
- Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, Washington, DC, USA
| | - Venu Menon
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - P Elliott Miller
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - L Kristin Newby
- Divison of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Sean van Diepen
- Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA
| | - Jason N Katz
- Divison of Cardiology, Duke University School of Medicine, Durham, NC, USA
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18
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Hartog CS, Maia PA, Ricou B, Danbury C, Galarza L, Schefold JC, Soreide E, Bocci MG, Pohrt A, Sprung CL, Avidan A. Changes in communication of end-of-life decisions in European ICUs from 1999 to 2016 (Ethicus-2) - a prospective observational study. J Crit Care 2021; 68:83-88. [PMID: 34952475 DOI: 10.1016/j.jcrc.2021.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We investigated changes in communication practice about end-of-life decisions in European ICUs over 16 years. MATERIALS AND METHODS This prospectively planned secondary analysis of two observational studies in 22 European ICUs in 1999-2000 (Ethicus-1) and 2015-16 (Ethicus-2) included consecutive patients who died or with limitation of life-sustaining therapy. ICUs were grouped into North, Central and South European regions. RESULTS A total 4592 patients were included in 1999-2000 (n = 2807) and 2015-16 (n = 1785). Information about patient wishes increased overall (from 25.4% [570] to 51.1% [840]) and in all regions (42% to 61% [North], 22% to 56% [Central] and 20% to 32% [South], all p < 0.001). Discussions of treatment limitations with patients or families increased overall (66.0% to 76.1%) and in Northern and Central Europe (87% to 94% and 75% to 82.2%, respectively, all p < 0.001) but not in the South. Strongest predictor for discussions was the region (North>Central>South) followed by patient decision-making capacity. CONCLUSION End-of-life decisions are increasingly discussed but communication practices vary by region and follow a North-South gradient. Despite increased availability of information, patient preferences still remain unknown in every second patient. This calls for increased efforts to assess patient preference in advance and make them known to ICU clinicians.
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Affiliation(s)
- Christiane S Hartog
- Department of Anesthesiology and Operative Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany; Klinik Bavaria, Kreischa, Germany.
| | - Paulo A Maia
- Intensive Care Medicine, Centro Hospitalar e Universitário do Porto, ICBAP, Porto, Portugal
| | - Bara Ricou
- Department of Acute Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Chris Danbury
- Intensive Care, Royal Berkshire Hospital, Reading, United Kingdom
| | - Laura Galarza
- Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Eldar Soreide
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Maria G Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anne Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Charles L Sprung
- Division of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Alexander Avidan
- Division of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
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19
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Benbenishty J, Ganz FD, Anstey MH, Barbosa-Camacho FJ, Bocci MG, Çizmeci EA, Dybwik K, Ingels C, Lautrette A, Miranda-Ackerman RC, Estebanez-Montiel B, Plowright C, Ricou B, Robertsen A, Sprung CL. Changes in intensive care unit nurse involvement in end of life decision making between 1999 and 2016: Descriptive comparative study. Intensive Crit Care Nurs 2021; 68:103138. [PMID: 34750044 DOI: 10.1016/j.iccn.2021.103138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/12/2021] [Accepted: 08/30/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Comparison of nurse involvement in end of life decision making in European countries participating in ETHICUS I- 1999 and ETHICUS II- 2015. METHODOLOGY This was a prospective observational study of 22 European ICUs included in the ETHICUS-II and I. Data were collected as per the ETHICUS-I and ETHICUS-II protocols. Four questions within the ETHICUS protocols related to nurse involvement in end of life decision making were analyzed. This is a comparison of changes in nurse involvement in end of life decisions from 1999 to 2015. SETTING International e-based questionnaire completed by an intensive care clinician when an end of life decision was performed on any patient. SUBJECTS Intensive care physicians and nurses, no interventions were performed. MEASUREMENTS A 20 question survey was used to describe the decision making process, on what basis was the decision made, who was involved in the decision making process, and what precise decisions were made. RESULTS A total of 4592 cases from 22 centres are included. While there was more agreement between nurses and physicians in ETHICUS-I compared to ETHICUS-I, fewer discussions with nurses occurred in ETHICUS-II. The frequency of end of life decisions that were discussed with nurses decreased in all three regions between ETHICUS-I and ETHICUS-II. CONCLUSION Based on the results of the current study, nurses should be further encouraged to increase their involvement in end of life decision-making, especially those in southern Europe.
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Affiliation(s)
- Julie Benbenishty
- Hadassah Hebrew University Medical Center and School of Nursing, Israel.
| | - Freda DeKeyser Ganz
- Hadassah Hebrew University School of Nursing and Jerusalem College of Technology, Israel.
| | - Matthew H Anstey
- Sir Charles Gairdner Hospital, Perth, Australia; School of Public Health, Curtin University, Perth, Australia; School of Medicine, University of Western Australia, Australia.
| | | | - Maria Grazia Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elif Ayşe Çizmeci
- University of Toronto, Faculty of Medicine, Interdepartmental Division of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Canada; Uludağ University, Faculty of Medicine, Department of Anesthesiology and Intensive Care, Bursa, Turkey
| | - Knut Dybwik
- Intensive Care Unit, Nordland Hospital, Bodø, Nord University, Bodø, Norway
| | - Catherine Ingels
- University Hospital Gasthuisberg Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, Herestraat 49, B-3000 Leuven, Belgium.
| | - Alexandre Lautrette
- Intensive Care Medicine, Gabriel-Montpied University Hospital, Clermont-Ferrand, France.
| | | | | | | | - Bara Ricou
- Intensive Care of Geneva, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva Hospital and University of Geneva, Switzerland.
| | - Annette Robertsen
- Department of Anesthesiology and Critical Care, Oslo University Hospital, Oslo, Norway.
| | - Charles L Sprung
- Department of Intensive Care, Hadassah Hebrew University Medical Center, Israel.
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20
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Rose L, Allum LJ, Istanboulian L, Dale C. Actionable processes of care important to patients and family who experienced a prolonged intensive care unit stay: Qualitative interview study. J Adv Nurs 2021; 78:1089-1099. [PMID: 34704627 DOI: 10.1111/jan.15083] [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: 08/11/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022]
Abstract
AIM To use positive deviance to identify actionable processes of care that may improve outcomes and experience from the perspectives of prolonged intensive care unit (ICU) stay survivors and family members. DESIGN Prospective qualitative interview study in two geographically distant settings: Canada (2018/19) and the United Kingdom (2019/20). METHODS Patient and family participant inclusion criteria comprised: aged over 18 years, ICU stay in last 2 years of over 7 days, able to recall ICU stay and provided informed consent. We conducted semi-structured in-person or telephone interviews. Data were analysed using a positive deviance approach. RESULTS We recruited 29 participants (15 Canadian; 14 UK). Of these, 11 were survivors of prolonged ICU stay and 18 family members. We identified 22 actionable processes (16 common to Canadian and UK participants, 4 Canadian only and 2 UK only). We grouped processes under three themes: physical and functional recovery (nine processes), patient psychological well-being (seven processes) and family relations (six processes). Most commonly identified physical/functional processes were regular physiotherapy, and fundamental hygiene and elimination care. For patient psychological well-being: normalizing the environment and routines, and alleviating boredom and loneliness. For family relations: proactive communication, flexible family visiting and presence with facilities for family. Our positive deviance analysis approach revealed that incorporation of these actionable processes into clinical practice was the exception as opposed to the norm perceived driven by individual acts of kindness and empathy as opposed to standardized processes. CONCLUSION Actionable processes of care important to prolonged ICU stay survivors and family members differ from those frequently used in ICU quality improvement (QI) tools. IMPACT Our study emphasizes the need to develop QI tools that standardize delivery of actionable processes important to patients and families experiencing a prolonged ICU stay. As the largest healthcare professional group, nurses can play an essential role in leading this.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Laura J Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Laura Istanboulian
- Michael Garron Hospital, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing and Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
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21
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Lopez-Soto C, Bates E, Anderson C, Saha S, Adams L, Aulakh A, Bowtell F, Buckel M, Emms T, Shebl M, Metaxa V. The Role of a Liaison Team in ICU Family Communication During the COVID 19 Pandemic. J Pain Symptom Manage 2021; 62:e112-e119. [PMID: 33892123 PMCID: PMC8057931 DOI: 10.1016/j.jpainsymman.2021.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT In the name of public safety, a general suspension on hospital visiting was imposed in the U.K., prohibiting family and friends to visit hospitalized patients, even if they were critically ill. OBJECTIVES we aimed to assess the impact of the FLT on the communication with patients' family and friends (PFF), especailly around end-of-life care, and their interaction with CC clinicians. METHODS A retrospective, mixed-methods analysis of a family liaison team (FLT) formed by redeployed clinicians in critical care (CC) during the first surge of the 2020 COVID 19 pandemic. RESULTS The FLT was constituted predominantly of non-ICU consultants (30/39, 77%). Following two one-hourly webinars around basic communication skills, the FLT facilitated over 12,000 video and telephone calls with 172 patients' family and friends (PFF). The majority of the PFF interviewed were mostly, very or extremely satisfied with the frequency, ease, understanding, honesty, completeness, and consistency of the information provided. Approximately 5% of the interviewees reported to be slightly or very dissatisfied in one or more of the following 3 categories: frequency, consistency, and ease of getting the information. The thematic analysis identified 3 themes: 1) being there with/ for the patient; 2) breakdown in communication; 3) disbelief at the speed of deterioration. In 14.9% of cases there was documented discrepancy between the information transmitted by the CC team and that by the FLT, particularly around the severity of the patient's illness and their imminent death. CONCLUSION The formation of a dedicated FLT was feasible and associated with high levels of satisfaction by the PFF. Friction was created when communication was not consistent and did not convey the severity of the patient's condition, to prepare the PFF for a bad outcome.
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Affiliation(s)
- Carmen Lopez-Soto
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Eleanor Bates
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Charlotte Anderson
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Sian Saha
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Laura Adams
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Alex Aulakh
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Francesca Bowtell
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Marie Buckel
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Thomas Emms
- Ashford & St Peter's Hospital NHS Trust, Ashford, UK
| | - Moustafa Shebl
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
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Safitri D, Kurnia A, Al Jihad M. Family Experience during Patient Assistance Process in General Intensive Care Unit: A Phenomenology Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Intensive care unit (ICU) treatment can lead to fear, anxiety, depression, panic, and tension in the family. Place of the family as active presence, guardian, facilitator, historian, and coaching of the family cannot be separated from the recovery process. During the assistance of ICU patients, the family is faced with a strange environment, strict rules, emotional stress, and everyday life changes that have caused them to encounter psychological and physiological concerns.
AIM: This study aims to describe and interpret of the family’s experience during assistance patient in the ICU.
METHODS: A phenomenological methodology is used to explore experience of family. In-depth interviews were conducted on nine participants who were selected using purposive sampling. Data were analyzed by Colaizzi techniques, began with read transcripts, look for phenomenon, formulated data, organized, and verified to the participants.
RESULTS: The result is presented in three themes; physically and psychologically tired; good language is a medicine, strengthens each other’s companion.
CONCLUSION: The support of the patient in the ICU helps the family face a number of stressful circumstances. Adaptive coping and psychosocial help from health care workers and friends build a supportive family to cope with the difficulties when supporting patients in the ICU.
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Aghaie B, Anoosheh M, Foroughan M, Mohammadi E, Kazemnejad A. A Whirlpool of Stress in Families of Intensive Care Unit Patients: A Qualitative Multicenter Study. Crit Care Nurse 2021; 41:55-64. [PMID: 34061191 DOI: 10.4037/ccn2021322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Family members of patients admitted to the intensive care unit must tolerate high levels of stress, making them emotionally and physically vulnerable. However, little is known about the kinds of stress family members may experience. OBJECTIVE To explore perceived stress in the families of patients admitted to the intensive care unit. METHODS This qualitative content analysis study involved 23 family members of patients admitted to intensive care units. Participants were drawn from family members of patients hospitalized in intensive care units of 3 public and 2 private hospitals. Data were collected through semistructured interviews. RESULTS Three themes emerged from the data: "distrust," "repeated stress exposure," and "a whirlpool of persistent negative emotional-physical state." The first theme had 2 categories: "fearful mindset" and "negative beliefs about professional caregivers." The second theme also had 2 categories: "fear of the future" and "sustained accumulation of tensions." The third theme had 3 categories: "impaired mental health," "impaired physical health," and "impaired family function." CONCLUSIONS The findings of this study may help critical care nurses better understand the nature and sources of family stresses during a patient's intensive care unit stay. Supervisory nurses should alert their staff to these issues so that family care programs can address them, thereby reducing family members' risk of posttraumatic stress disorder and post-intensive care syndrome-family.
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Affiliation(s)
- Bahman Aghaie
- Bahman Aghaie is an assistant professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Monireh Anoosheh
- Monireh Anoosheh is an associate professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mahshid Foroughan
- Mahshid Foroughan is an associate professor, Research Center on Aging, Department of Gerontology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Esa Mohammadi
- Esa Mohammadi is a professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University
| | - Anoshirvan Kazemnejad
- Anoshirvan Kazemnejad is a professor, Department of Biostatistics, Faculty of Medicine, Tarbiat Modares University
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Xyrichis A, Fletcher S, Philippou J, Brearley S, Terblanche M, Rafferty AM. Interventions to promote family member involvement in adult critical care settings: a systematic review. BMJ Open 2021; 11:e042556. [PMID: 33827833 PMCID: PMC8031009 DOI: 10.1136/bmjopen-2020-042556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify, appraise and synthesise evidence of interventions designed to promote family member involvement in adult critical care units; and to develop a working typology of interventions for use by health professionals and family members. DESIGN Mixed-method systematic review. DATA SOURCES Bibliographic databases were searched without date restriction up to June 2019: MEDLINE, EMBASE and CINAHL; the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Back issues of leading critical care and patient experience journals were manually searched, as were the reference lists of included studies. All evaluation studies of relevant intervention activities were included; all research designs and outcome measures were eligible. Due to heterogeneity in interventions, designs and outcome measures, the synthesis followed a narrative approach. Service users met with the research team termly. RESULTS Out of 4962 possible citations, a total of 20 studies were included. The overall evidence base was assessed as moderate to weak. Six categories of interventions were identified: environmental unit changes (n=2), web-based support (n=4), discussion-based support (n=6), multicomponent support (n=4), participation in rounds (n=3) and participation in physical care (n=1). Clinical and methodological heterogeneity across studies hindered meta-analysis, hence a narrative synthesis was pursued. Six main outcomes were identified, grouped under two categories: (i) involvement outcomes: communication (mean difference ranged from 6.39 to 8.83), decision-making (mean difference ranged from -0.8 to 5.85), satisfaction (mean difference ranged from 0.15 to 2.48); and (ii) health outcomes: family trauma (mean difference ranged from -7.12 to 0.9), family well-being (mean difference ranged from -0.7 to -4), patient outcomes (relative risk ranged from 1.27 to 4.91). The findings from the qualitative studies were thematically analysed to identify features of the interventions that participants perceived to influence effectiveness. Synthesised into five overarching categories (practicality, development, interaction, reflexivity and bridging), these can serve as principles to inform the future design and development of more refined family member involvement interventions. CONCLUSIONS Future interventions should be developed with much closer family member input and designed by considering the key features we identified. We call for future interventions to be multilayered and allow for a greater or lesser level, and different kinds, of involvement for family members. Choice of intervention should be informed by a baseline diagnostic of family members' needs, readiness and preparedness for involvement. PROSPERO REGISTRATION CRD42018086325.
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Affiliation(s)
- Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Simon Fletcher
- Health, Social Care and Education, Kingston and St Georges University London, London, England, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Sally Brearley
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Marius Terblanche
- Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
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Labuschagne D, Torke A, Grossoehme D, Rimer K, Rucker M, Schenk K, Slaven JE, Fitchett G. Chaplaincy Care in the MICU: Examining the Association Between Spiritual Care and End-of-Life Outcomes. Am J Hosp Palliat Care 2021; 38:1409-1416. [PMID: 33464118 DOI: 10.1177/1049909120987218] [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: 11/16/2022] Open
Abstract
BACKGROUND Seriously ill patients admitted to the Intensive Care Unit (ICU) experience severe spiritual and existential distress. Patients' surrogate decision makers face the burden of making complex decisions about their loved ones' care. Experienced chaplains may play a role in assisting with decision-making, possibly by aligning patients' values and wishes with treatment plans and avoiding non-beneficial aggressive measures. OBJECTIVES To identify associations between chaplaincy care and length of stay (LOS) in the medical ICU (MICU). METHODS This was a retrospective observational study of usual spiritual care in the adult MICUs of 4 medical centers in the United States over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information. Through bivariate and multivariable analyses associations between spiritual care and LOS were examined. RESULTS In multivariable analysis of the 254 patients, receiving spiritual care was associated with an increased likelihood of being in a higher LOS tertile (adjusted odds ratio = 2.94, p < .001). In post hoc bivariate analysis, cases receiving spiritual care within the first 48 hours of MICU admission revealed a trend toward lower LOS (p = .181). CONCLUSION Spiritual care in the MICU was associated with longer LOS. Early intervention by chaplains who are well-integrated in the ICU may assist patients and their loved ones in coming to terms with grave illness and making difficult treatment decisions. Further well-designed studies of spiritual care interventions that may affect outcomes are needed.
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Affiliation(s)
| | - Alexia Torke
- Indiana University School of Medicine, Daniel F Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, IN, USA
| | - Daniel Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, OH, USA
| | - Katie Rimer
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Kristen Schenk
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
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Mistraletti G, Gristina G, Mascarin S, Iacobone E, Giubbilo I, Bonfanti S, Fiocca F, Fullin G, Fuselli E, Bocci MG, Mazzon D, Giusti GD, Galazzi A, Negro A, De Iaco F, Gandolfo E, Lamiani G, Del Negro S, Monti L, Salvago F, Di Leo S, Gribaudi MN, Piccinni M, Riccioni L, Giannini A, Livigni S, Maglione C, Vergano M, Marinangeli F, Lovato L, Mezzetti A, Drigo E, Vegni E, Calva S, Aprile A, Losi G, Fontanella L, Calegari G, Ansaloni C, Pugliese FR, Manca S, Orsi L, Moggia F, Scelsi S, Corcione A, Petrini F. How to communicate with families living in complete isolation. BMJ Support Palliat Care 2020:bmjspcare-2020-002633. [PMID: 33060189 DOI: 10.1136/bmjspcare-2020-002633] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
Abstract
IMPORTANCE During the SARS-CoV-2 pandemic, a complete physical isolation has been worldwide introduced. The impossibility of visiting their loved ones during the hospital stay causes additional distress for families: in addition to the worries about clinical recovery, they may feel exclusion and powerlessness, anxiety, depression, mistrust in the care team and post-traumatic stress disorder. The impossibility of conducting the daily meetings with families poses a challenge for healthcare professionals. OBJECTIVE This paper aims to delineate and share consensus statements in order to enable healthcare team to provide by telephone or video calls an optimal level of communication with patient's relatives under circumstances of complete isolation. EVIDENCE REVIEW PubMed, Cochrane Database of Systematic Reviews, Database of Abstracts and Reviews of Effectiveness and the AHCPR Clinical Guidelines and Evidence Reports were explored from 1999 to 2019. Exclusion criteria were: poor or absent relevance regarding the aim of the consensus statements, studies prior to 1999, non-English language. Since the present pandemic context is completely new, unexpected and unexplored, there are not randomised controlled trials regarding clinical communication in a setting of complete isolation. Thus, a multiprofessional taskforce of physicians, nurses, psychologists and legal experts, together with some family members and former intensive care unit patients was established by four Italian national scientific societies. Using an e-Delphi methodology, general and specific questions were posed, relevant topics were argumented, until arriving to delineate position statements and practical checklist, which were set and evaluated through an evidence-based consensus procedure. FINDINGS Ten statements and two practical checklists for phone or video calls were drafted and evaluated; they are related to who, when, why and how family members must be given clinical information under circumstances of complete isolation. CONCLUSIONS AND RELEVANCE The statements and the checklists offer a structured methodology in order to ensure a good-quality communication between healthcare team and family members even in isolation, confirming that time dedicated to communication has to be intended as a time of care.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy
| | - Giuseppe Gristina
- Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Roma, Italy
| | - Sara Mascarin
- Educational Services for Health and Social Development, Officina Comunicativa, Treviso, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Ilaria Giubbilo
- General and Neurosurgical ICU, Ospedale dell'Angelo, Aulss 3 Serenissima Veneto, Venezia, Italy
| | - Silvia Bonfanti
- Department of Palliative Care, Azienda USL di Piacenza, Piacenza, Italy
| | - Federico Fiocca
- Anestesia e Rianimazione 1, ASST Spedali Civili, Brescia, Italy
| | - Giorgio Fullin
- General and Neurosurgical ICU, Ospedale dell'Angelo, Aulss 3 Serenissima Veneto, Venezia, Italy
| | - Ennio Fuselli
- UOC Anestesia Rianimazione 1 Dip.to Emergenza Accettazione, A. O. San Camillo-Forlanini, Roma, Italy
| | - Maria Grazia Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Terapia Intensiva, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Davide Mazzon
- UOC Anestesia e Rianimazione, Ospedale di Belluno, Aulss 1 Dolomiti, Belluno, Italy
| | | | - Alessandro Galazzi
- Direction of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Fabio De Iaco
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy
| | - Enrico Gandolfo
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy
| | - Giulia Lamiani
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Silvia Del Negro
- UOC Clinical Psychology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Laura Monti
- Servizio Psicologia Ospedaliera, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Fabrizia Salvago
- Dipartimento di Neuroscienze, Azienda Ospedaliera G Brotzu, Cagliari, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Mariassunta Piccinni
- Department of Political Science, Law and International Studies, Università degli Studi di Padova, Padova, Italy
| | | | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Sergio Livigni
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Carla Maglione
- Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Napoli, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Franco Marinangeli
- Department of Anesthesiology and Intensive Care, University of L'Aquila, L'Aquila, Italy
| | - Luisa Lovato
- UO Anestesia e Rianimazione 1, Ospedale Santa Chiara, Trento, Italy
| | | | - Elio Drigo
- Associazione Nazionale Infermieri di Area Critica (Aniarti), Udine, Italy
| | - Elena Vegni
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
- UOC Clinical Psychology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Sally Calva
- Educational Services for Health and Social Development, Officina Comunicativa, Torino, Italy
| | - Anna Aprile
- Department of Molecular Medicine, Università degli Studi di Padova, Padova, Italy
| | | | - Lucia Fontanella
- Dipartimento di Scienze del Linguaggio e Letterature moderne e comparate, Università degli Studi di Torino, Torino, Italy
| | | | | | | | - Salvatore Manca
- SC Medicina e Chirurgia di Accettazione e di Urgenza, Ospedale di Oristano, Oristano, Italy
| | - Luciano Orsi
- Società Italiana di Cure Palliative (SICP), Milano, Italy
| | - Fabrizio Moggia
- DATeR Processo Assistenziale nelle Cure Palliative, Azienda USL di Bologna, Bologna, Italy
| | - Silvia Scelsi
- Dipartimento Infermieristico e delle professioni tecnico sanitarie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Antonio Corcione
- UOC Anestesia e TIPO, Azienda dei Colli, Ospedale Monaldi-Cotugno, Napoli, Italy
| | - Flavia Petrini
- Perioperative Medicine, Pain Therapy, ICU and Emergency Department, ASL2 - Chieti Pescara University, Chieti, Italy
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Vigué B, Radiguer F. Dialogue avec l’entourage des patients en réanimation. LE PRATICIEN EN ANESTHÉSIE RÉANIMATION 2020; 24:250-258. [PMID: 32982543 PMCID: PMC7508493 DOI: 10.1016/j.pratan.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La place donnée à l’entourage de nos patients a accompli un changement profond dans les réanimations. Travailler à des discussions collégiales avec les soignants, reconnaître la parole des patients mais aussi de leurs proches dans les projets de soins est devenu une part obligatoire de notre travail quotidien. Ce changement de considération se perçoit aussi dans l’attention accordée aux partages des décisions éthiques. La confiance dans le système de soins comme auprès des intervenants médicaux est nécessaire pour que la relation thérapeutique puisse se faire sereinement. Il nous faut donc s’organiser pour perfectionner l’accueil des familles, la place de l’équipe, les réunions formelles régulières d’information auprès des proches ou du représentant de notre patient. Le stress post traumatique n’est pas seulement l’apanage des patients rescapés de réanimation, il est décrit aussi chez les accompagnants. Si la confiance est acquise, peu de conflits avec la famille sont insurmontables, seuls les conflits interfamiliaux obligent l’équipe médicale à défendre son opinion. La prise de conscience qu’un projet de soin à la sortie de réanimation réussira mieux quand il se fait avec l’appui de l’entourage, permet de comprendre l’importance à accorder aux proches et à leur stress.
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Dhala A, Sasangohar F, Kash B, Ahmadi N, Masud F. Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study. J Med Internet Res 2020; 22:e20143. [PMID: 32795997 PMCID: PMC7473763 DOI: 10.2196/20143] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/19/2020] [Accepted: 08/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. OBJECTIVE The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients' families during the pandemic. METHODS The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non-COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non-COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. RESULTS Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. CONCLUSIONS Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.
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Affiliation(s)
- Atiya Dhala
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.,Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Bita Kash
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,School of Public Health, Texas A&M University, College Station, TX, United States
| | - Nima Ahmadi
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Faisal Masud
- Departments of Anesthesiology and Critical Care, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States
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Van Keer RL, Deschepper R, Huyghens L, Bilsen J. Withholding/Withdrawing Life-Sustaining Treatment in a Multiethnic Critical Care Setting: An Ethnographic Study. J Palliat Med 2020; 24:338-346. [PMID: 32721261 DOI: 10.1089/jpm.2019.0653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Critical care physicians often have to make challenging decisions to withhold/withdraw life-sustaining treatments. As a result of society's increasingly cultural diversity such decision making often involves patients from ethnic minority groups, which might pose extra challenges. Objective: To investigate withholding/withdrawing life-sustaining treatments with patients from ethnic minority groups and their families during critical care. Design: Ethnographic fieldwork (observations, in-depth interviews and reading patients' medical files). Setting/Subjects: Eighteen patients from ethnic minority groups, their relatives, physicians and nurses were studied in one intensive care unit of a multi-ethnic urban hospital (Belgium). Results: During decision making physicians had a very central role. The contribution of patients and nurses was limited, while families' input was more noticeable. Decision making was hampered by communication difficulties between: (1) staff and relative(s), (2) relatives, and (3) patient and relative(s). Different approaches were used by physicians to overcome difficulties, which often reflected their tendency to control decision making, for example, stressing their central role. At times their approaches reflected their inability to align families' wishes with their own, for example, when making decisions without explicitly informing relatives. Conclusions: Withholding/withdrawing life-sustaining treatments in a multi-ethnic critic care context has a number of alarming difficulties, such as how to take families' input correctly into account. It is important that decision making happens in a cultural sensitive way and with involvement tailored to patients' and relatives' needs and in close consultation with interprofessional health care workers/other services.
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Affiliation(s)
- Rose-Lima Van Keer
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Reginald Deschepper
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Luc Huyghens
- Critical Care Department, Vrije Universiteit Brussel, Brussels, Belgium.,Service of Intensive Care Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
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Wu F, Zhuang Y, Chen X, Wen H, Tao W, Lao Y, Zhou H. Decision-making among the substitute decision makers in intensive care units: An investigation of decision control preferences and decisional conflicts. J Adv Nurs 2020; 76:2323-2335. [PMID: 32538477 DOI: 10.1111/jan.14451] [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: 10/22/2019] [Revised: 04/10/2020] [Accepted: 05/22/2020] [Indexed: 01/22/2023]
Abstract
AIMS To explore decision control preferences and decisional conflicts and to analyse their association among the surrogate decision makers in the intensive care unit. DESIGN The study carried out a cross-sectional survey among the surrogates. METHODS The participants were 115 surrogate decision makers of critical patients, from August to September 2019. A Chi-squared test and logistic regression were used to assess decision control preferences and decisional conflicts, and Spearman's rank correlation coefficient was employed to examine their association. RESULTS Of the 115 surrogate decision makers, 51.3% preferred a collaborative role, and 63.48% were somewhat unsure about making decisions. Logistic regression analysis identified decision control preferences was associated with surrogates' age, education level, and personality traits, while decisional conflicts was associated with surrogates' age, education level, character, medical expense burden, and Acute Physiology and Chronic Health Evaluation-II score. Cohen's kappa statistics showed a bad concordance of decision-making expectations and actuality, with kappa values of 0.158 (p < .05). Wherein surrogates who experienced discordance between their preferred and actual roles, have relatively higher decisional conflicts. CONCLUSION This study identified individual differences of surrogate decision makers in decision control preferences and decisional conflicts. These results imply that incorporation of the individual decision preferences and communication styles into care plans is an important first step to develop high quality decision support. IMPACT This research is a contribution to the limited study on decision control preferences and decisional conflicts among surrogate decision makers of critically ill patients. Moreover based on the investigation of understanding the status and related factors of decision preferences and decisional conflicts set the stage for developing effective decision support interventions.
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Affiliation(s)
- Feixia Wu
- School of Nursing, Huzhou University, Huzhou, China
| | - Yiyu Zhuang
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiangping Chen
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huan Wen
- School of Nursing, Huzhou University, Huzhou, China
| | - Wenwen Tao
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuewen Lao
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongchang Zhou
- School of Medicine and Nursing Sciences, Huzhou University, Huzhou Central Hospital, Huzhou, China
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El-Rouby D, McNaughton N, Piquette D. Painting a Rational Picture During Highly Emotional End-of-Life Discussions: a Qualitative Study of Internal Medicine Trainees and Faculty. J Gen Intern Med 2020; 35:1167-1174. [PMID: 31898140 PMCID: PMC7174481 DOI: 10.1007/s11606-019-05615-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/23/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND High-quality communication about end-of-life care results in greater patient and family satisfaction. End-of-life discussions should occur early during the patient's disease trajectory and yet is often addressed only when patients become severely ill. As a result, end-of-life discussions are commonly initiated during unplanned hospital admissions, which create additional challenges for physicians, patients, and families. OBJECTIVE To better understand how internal medicine attending physicians and trainees experience end-of-life discussions with patients and families during acute hospitalizations. DESIGN We conducted an interview-based qualitative study using an interpretivist approach. We selected participants based on purposeful maximal variation and theoretical sampling strategies. We conducted an individual, in-depth, semi-structured interview with each participant. PARTICIPANTS We recruited 15 internal medicine physicians with variable levels of clinical training and experience who worked in one of five university-affiliated academic hospitals. APPROACH Interview transcripts were analyzed inductively and reflectively. Data were grouped by themes and categories. Data collection and analysis occurred concurrently, led to iterative adjustments of the interview guide, and continued until theoretical sufficiency was reached. KEY RESULTS Physicians depicted end-of-life discussions as a process directed at painting a realistic picture of a clinical situation. By focusing their efforts on reaching a shared understanding of a clinical situation with patients/families, physicians self-delineated the boundaries of their professional responsibilities regarding end-of-life care (i.e., help with understanding, not with accepting or making the "right" decisions). Information sharing took precedence over emotional support in most physicians' accounts of end-of-life discussions. However, the emotional impact of end-of-life discussions on families and physicians was readily recognized by participants. CONCLUSION End-of-life discussions are complex, dynamic social interactions that involve multiple, complementary competencies. Focusing mostly on sharing clinical information during end-of-life discussions may distract physicians from providing emotional support to families and prevent improvements of end-of-life care delivered in acute care settings.
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Affiliation(s)
- Doaa El-Rouby
- Faculty of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
| | - Nancy McNaughton
- Faculty of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
| | - Dominique Piquette
- Faculty of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada.
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room D108, Toronto, ON, M4N 3M5, Canada.
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Quenot JP, Meunier-Beillard N, Ksiazek E, Abdulmalak C, Berrichi S, Devilliers H, Ecarnot F, Large A, Roudaut JB, Andreu P, Dargent A, Rigaud JP. Criteria deemed important by the relatives for designating a reference person for patients hospitalized in ICU. J Crit Care 2020; 57:191-196. [PMID: 32179249 DOI: 10.1016/j.jcrc.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/09/2020] [Accepted: 02/25/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE We investigated the criteria that patients' relatives deem important for choosing, among themselves, the person best qualified to interact with the caregiving staff. METHODS Exploratory, observational, prospective, multicentre study between 1st March and 31st October 2018 in 2 intensive care units (ICUs). A 12-item questionnaire was completed anonymously by family members of patients hospitalized in the ICU 3 and 5 days after the patient's admission. Relatives were eligible if they understood French and if no surrogate had been appointed by the patient prior to ICU admission. More than one relative per patient could participate. RESULTS In total, 87 relatives of 73 patients completed the questionnaire, average age of relatives was 58 ± 15 years, 46% were the spouse, 30% were children/grandchildren. Items classed as being the most important attributes for a reference person were: good knowledge of the patient's wishes and values; an emotional attachment to the patient; being a family member; and having an adequate understanding of the clinical status and clinical history. CONCLUSION This study identifies the attributes considered by relatives to be most important for designating, among themselves, a reference person for a patient hospitalized in the ICU.
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Affiliation(s)
- Jean-Pierre Quenot
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France; Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.
| | - Nicolas Meunier-Beillard
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France; DRCI, USMR, CHU Dijon, Bourgogne, France.
| | - Eléa Ksiazek
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.
| | - Caroline Abdulmalak
- Department of Intensive Care, Centre Hospitalier William Morey, Châlon sur Saône, France.
| | - Samia Berrichi
- Department of Intensive Care, Centre Hospitalier de Dieppe, France
| | - Hervé Devilliers
- Department of Internal Medicine, François Mitterrand University Hospital, Dijon, France.
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, France.
| | - Audrey Large
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France.
| | - Jean-Baptiste Roudaut
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France.
| | - Pascal Andreu
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France.
| | - Auguste Dargent
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France; Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, France; Espace de Réflexion Ethique de Normandie, University Hospital Caen, France.
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Ganz FD. Improving Family Intensive Care Unit Experiences at the End of Life: Barriers and Facilitators. Crit Care Nurse 2020; 39:52-58. [PMID: 31154331 DOI: 10.4037/ccn2019721] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Experiencing the end of life of a family member in the intensive care unit is clearly difficult. An important role of critical care nurses is to help family members through this challenging period. This article highlights a few clinically significant barriers and facilitators related to improving family experiences at the patient's end of life that have received less attention in the literature thus far. Facilitators include specific aspects of communication, the nurse's role as the coordinator of care, bereavement care, promoting a "good death," and caring for health care providers. Barriers include medical uncertainty and differences in values and culture.
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Affiliation(s)
- Freda DeKeyser Ganz
- Freda DeKeyser Ganz is Department Chair, Hadassah-Hebrew University School of Nursing, Jerusalem, Israel.
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Crawshaw J, Presseau J, van Allen Z, Pinheiro Carvalho L, Jordison K, English S, Fergusson DA, Lauzier F, Turgeon AF, Sarti AJ, Martin C, D'Aragon F, Li AHT, Knoll G, Ball I, Brehaut J, Burns KEA, Fortin MC, Weiss M, Meade M, Marsolais P, Shemie S, Zaabat S, Dhanani S, Kitto SC, Chassé M. Exploring the experiences and perspectives of substitute decision-makers involved in decisions about deceased organ donation: a qualitative study protocol. BMJ Open 2019; 9:e034594. [PMID: 31874899 PMCID: PMC7008441 DOI: 10.1136/bmjopen-2019-034594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In Canada, deceased organ donation provides over 80% of transplanted organs. At the time of death, families, friends or others assume responsibility as substitute decision-makers (SDMs) to consent to organ donation. Despite their central role in this process, little is known about what barriers, enablers and beliefs influence decision-making among SDMs. This study aims to explore the experiences and perspectives of SDMs involved in making decisions around the withdrawal of life-sustaining therapies, end-of-life care and deceased organ donation. METHODS AND ANALYSIS SDMs of 60 patients admitted to intensive care units will be enrolled for this study. Ten hospitals across five provinces in Canada in a prospective multicentre qualitative cohort study. We will conduct semistructured telephone interviews in English or French with SDMs between 6 and 8 weeks after the patient's death. Our sampling frame will stratify SDMs into three groups: SDMs who were not approached for organ donation; SDMs who were approached and consented to donate and SDMs who were approached but did not consent to donate. We will use two complementary theoretical frameworks-the Common-Sense Self-Regulation Model and the Theoretical Domains Framework- to inform our interview guide. Interview data will be analysed using deductive directed content analysis and inductive thematic analysis. ETHICS AND DISSEMINATION This study has been approved by the Centre Hospitalier de l'Université de Montréal Research Ethics Board. The findings from this study will help identify key factors affecting substitute decision-making in deceased organ donation, reasons for non-consent and barriers to achieve congruency between SDM and patient wishes. Ultimately, these data will contribute to the development and evaluation of tools and training for healthcare providers to support SDMs in making decisions about organ donation. TRIAL REGISTRATION NUMBER NCT03850847.
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Affiliation(s)
- Jacob Crawshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Zack van Allen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kim Jordison
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Francois Lauzier
- Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), CHU de Quebec-Universite Laval, Quebec City, Québec, Canada
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Quebec City, Québec, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), CHU de Quebec-Universite Laval, Quebec City, Québec, Canada
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Quebec City, Québec, Canada
| | - Aimee J Sarti
- Critical Care Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Claudio Martin
- Medicine (Critical Care), Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Frédérick D'Aragon
- Anesthesiology, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Alvin Ho-Ting Li
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Greg Knoll
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ian Ball
- Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karen E A Burns
- Critical Care, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marie-Chantal Fortin
- Medicine (Critical Care), Centre Hospitalier de L'Universite de Montreal, Montréal, Québec, Canada
- Medicine (Critical Care), Université de Montréal, Montreal, Québec, Canada
| | - Matthew Weiss
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
- Trauma-Emergency-Critical Care Medicine, Université Laval Faculté de médecine, Quebec City, Quebec, Canada
| | - Maureen Meade
- Medicine (Critical Care), McMaster University, Hamilton, Ontario, Canada
| | - Pierre Marsolais
- Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Sam Shemie
- Critical Care, McGill University, Montreal, Québec, Canada
| | | | | | - Simon C Kitto
- Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Michaël Chassé
- Innovation Hub, Centre de Recherche du CHUM, Montréal, Québec, Canada
- Medicine (Critical Care), Centre Hospitalier de L'Universite de Montreal, Montréal, Québec, Canada
- Medicine (Critical Care), Université de Montréal, Montreal, Québec, Canada
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Burns KEA, Misak C, Herridge M, Meade MO, Oczkowski S. Patient and Family Engagement in the ICU. Untapped Opportunities and Underrecognized Challenges. Am J Respir Crit Care Med 2019; 198:310-319. [PMID: 29624408 DOI: 10.1164/rccm.201710-2032ci] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The call for meaningful patient and family engagement in health care and research is gaining impetus. Healthcare institutions and research funding agencies increasingly encourage clinicians and researchers to work actively with patients and their families to advance clinical care and research. Engagement is increasingly mandated by healthcare organizations and is becoming a prerequisite for research funding. In this article, we review the rationale and the current state of patient and family engagement in patient care and research in the ICU. We identify opportunities to strengthen engagement in patient care by promoting greater patient and family involvement in care delivery and supporting their participation in shared decision-making. We also identify challenges related to patient willingness to engage, barriers to participation, participant risks, and participant expectations. To advance engagement, clinicians and researchers can develop the science behind engagement in the ICU context and demonstrate its impact on patient- and process-related outcomes. In addition, we provide practical guidance on how to engage, highlight features of successful engagement strategies, and identify areas for future research. At present, enormous opportunities remain to enhance engagement across the continuum of ICU care and research.
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Affiliation(s)
- Karen E A Burns
- 1 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and.,3 Department of Clinical Epidemiology and Biostatistics and
| | - Cheryl Misak
- 4 Department of Philosophy, University of Toronto, Toronto, Ontario, Canada; and
| | - Margaret Herridge
- 1 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and
| | - Maureen O Meade
- 3 Department of Clinical Epidemiology and Biostatistics and.,5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Simon Oczkowski
- 3 Department of Clinical Epidemiology and Biostatistics and.,5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Hensley MK. A Tale of Two Lungs. JAMA 2019; 322:613-614. [PMID: 31429900 DOI: 10.1001/jama.2019.11287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Xyrichis A, Fletcher S, Brearley S, Philippou J, Purssell E, Terblanche M, Rafferty AM, Reeves S. Interventions to promote patients and families' involvement in adult intensive care settings: a protocol for a mixed-method systematic review. Syst Rev 2019; 8:185. [PMID: 31345261 PMCID: PMC6657078 DOI: 10.1186/s13643-019-1102-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/10/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There has been an identified need for greater patient and family member involvement in healthcare. This is particularly relevant in an intensive care unit (ICU), as the family provides a key communicative and practical link between patient and clinician. Family members have been deemed a positive beneficial influence on ICU care and recovery processes, yet they themselves are often emotionally affected after discharge. There has been no standardised evidenced-based approach which explores research on family member involvement and the range and quality of contributions remain unclear. This project will undertake a systematic review to assess the evidence base for interventions designed to promote patient and family member involvement in adult intensive care settings and develop a comprehensive typology of interventions for use by clinicians, patients and carers. METHODS The following databases will be searched without date restriction: MEDLINE, EMBASE and CINAHL, as well as the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Manual searches of recent back issues of leading ICU and patient experience journals will also be undertaken, as will the reference lists of included studies. Unpublished literature will be sought through grey literature databases, including GreyLit and OpenGrey. All evaluation studies that consider intervention activities to promote patient and family member involvement in adult ICUs will be included; all research designs will be eligible. We will seek to include studies that report on a mixture of relevant outcomes for patients and family members. Abstracts and papers will be independently screened by at least two members of the team to determine their inclusion. Included papers will be assessed for methodological rigour using a standard rating approach, which assesses 'quality of study' and 'quality of information'. Quality assessment will be completed by at least two members of the team. Data on interventions, evaluation methods and outcomes will be collated using a predetermined extraction table. These are likely to be heterogeneous in nature, which will mean that the review will follow a narrative approach to synthesis. DISCUSSION The review will provide valuable and rigorous insight into the range and quality of interventions available to promote patient and family member involvement in ICU. This is the first step towards addressing the absence of a synthesis of research for this context, and will, in addition, develop a typology of available interventions that will help service users and clinicians make informed decisions about the approaches to patient and family member involvement which they might want to adopt. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42018086325).
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Affiliation(s)
- Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, James Clerk Maxwell Building, Waterloo, London, UK
| | - Simon Fletcher
- Kingston and St. George’s University London, St. George’s University, Hunter Wing 6th Floor, Tooting, London, UK
| | - Sally Brearley
- Kingston and St. George’s University London, St. George’s University, Hunter Wing 6th Floor, Tooting, London, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, James Clerk Maxwell Building, Waterloo, London, UK
| | - Ed Purssell
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, James Clerk Maxwell Building, Waterloo, London, UK
| | | | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, James Clerk Maxwell Building, Waterloo, London, UK
| | - Scott Reeves
- Kingston and St. George’s University London, St. George’s University, Hunter Wing 6th Floor, Tooting, London, UK
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Van Keer RL, Deschepper R, Huyghens L, Bilsen J. Preventing Conflicts Between Nurses and Families of a Multi-ethnic Patient Population During Critical Medical Situations in a Hospital. J Transcult Nurs 2019; 31:250-256. [DOI: 10.1177/1043659619859049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Little is known about how to avoid intercultural nurse–family conflicts in critical care settings. In this article, strategies are discussed that may be useful to prevent or mitigate intercultural nurse–family conflicts during critical medical situations in hospital. Method: Strategies are based on an ethnographic study by Van Keer et al., other literature, and expert opinion. Results: Sufficient structural measures are needed. First, institutions must create appropriate ward policies, such as including nurses in end-of-life communication. Second, nurses should be coached in the workplace. Third, institutions must provide adapted, visual, ward information to families. Additionally, education and research are needed. These measures should be actively stimulated by nurse managers and reflect a multicultural program supported by the hospital. Discussion: Intercultural nurse–family conflict prevention or mitigation should take into account organizational aspects, on hospital units and in hospital as a whole, and the crucial role of education and research.
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Affiliation(s)
| | | | - Luc Huyghens
- Vrije Universiteit Brussel, Brussels, Belgium
- Universitair Ziekenhuis Brussel, Brussels, Belgium
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Roche SD, Reichheld AM, Demosthenes N, Johansson AC, Howell MD, Cocchi MN, Landon BE, Stevens JP. Measuring the quality of inpatient specialist consultation in the intensive care unit: Nursing and family experiences of communication. PLoS One 2019; 14:e0214918. [PMID: 30973891 PMCID: PMC6459595 DOI: 10.1371/journal.pone.0214918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/24/2019] [Indexed: 12/04/2022] Open
Abstract
RATIONALE Critically ill patients in the intensive care unit (ICU) often require the care of specialist physicians for clinical or procedural expertise. The current state of communication between specialist physicians and families and nurses has not been explored. OBJECTIVES To document the receipt of communication by nurses and family members regarding consultations performed on their patient or loved one, and to quantify how this impacts their overall perceptions of the quality of specialty care. METHODS Prospective survey of 60 adult family members and 90 nurses of 189 ICU patients who received a specialist consultation between March and October of 2015 in a single academic medical center in the United States. Surveys measured the prevalence of direct communication-defined as communication conducted in person, via telephone, or via text-page in which the specialist team gathered information about the patient from the nurse/family member and/or shared recommendations for care-and perceived quality of care. RESULTS In about two-thirds of family surveys (40/60) and one-half of nurse surveys (75/160), respondents had no direct communication with the specialist team that performed the consultation. Compared to nurses who had no direct communication with the specialists, those who did were 1.5 times more likely to rate the consultation as "excellent" (RR 1.48, 95% CI 1.2-1.8, p<0.001). Nearly 40% (22/60) of families knew so little about the consultation that they felt incapable of evaluating it. CONCLUSIONS Most ICU families and nurses have no interaction with specialist providers. Nurses' frequent exclusion from conversations about specialty care may pose safety risks and increase the likelihood of mixed messages for patients and families, most of whom desire some interaction with specialists. Future research is needed to identify effective mechanisms for information sharing that keep nurses and families aware of consultation requests, delivery, and outcomes without increasing the risk of mixed messages.
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Affiliation(s)
- Stephanie D. Roche
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Alyse M. Reichheld
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Nicholas Demosthenes
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Anna C. Johansson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael D. Howell
- Center for Health Care Delivery Science and Innovation, University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Michael N. Cocchi
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bruce E. Landon
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jennifer P. Stevens
- Department of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Center for Health Care Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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Bäckström J, Willebrand PM, Öster C. Identifying the Needs of Family Members in Burn Care—Nurses’ Different Approaches. J Burn Care Res 2019; 40:336-340. [DOI: 10.1093/jbcr/irz018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Josefin Bäckström
- Department of Neuroscience, Psychiatry, Uppsala University, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | | | - Caisa Öster
- Department of Neuroscience, Psychiatry, Uppsala University, Sweden
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McAndrew NS, Schiffman R, Leske J. Relationships among Climate of Care, Nursing Family Care and Family Well-being in ICUs. Nurs Ethics 2019; 26:2494-2510. [PMID: 30832534 DOI: 10.1177/0969733019826396] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frequent exposure to ethical conflict and a perceived lack of organizational support to address ethical conflict may negatively influence nursing family care in the intensive care unit. RESEARCH AIMS The specific aims of this study were to determine: (1) if intensive care unit climate of care variables (ethical conflict, organizational resources for ethical conflict, and nurse burnout) were predictive of nursing family care and family wellbeing and (2) direct and indirect effects of the climate of care on the quality of nursing family care and family wellbeing. RESEARCH DESIGN A cross-sectional, correlational design was used. PARTICIPANTS AND RESEARCH CONTEXT Convenience sample of 111 nurses and 44 family members from five intensive care units at a Midwest hospital in the United States. INSTRUMENTS The Ethical Conflict Questionnaire-Critical Care Version, Maslach Burnout Inventory-Human Services Survey and Hospital Ethical Climate Scale were used to measure climate of care. The Family-Centered Care-Adult Version and Nurse Provided Family Social Support Scale were family measures of the quality of nursing family care. The Family Wellbeing Index was used to measure family wellbeing. DATA ANALYSIS Hierarchical regression and mediation analysis were used to answer the study aims. ETHICAL CONSIDERATIONS The study was approved by the Institutional Review Board at the study site. FINDINGS In separate regression models, organizational resources for ethical conflict (β = .401, p = .006) and depersonalization (β = -.511, p = .006), a component of burnout, were significant predictors of family-centered care. In simple mediation analysis the relationship between organizational resources for ethical conflict and family-centered care was mediated by depersonalization (β = .341, 95% confidence interval (.015, .707)). DISCUSSION Inadequate organizational resources and depersonalization may be related to family care delivery, and present obstacles to family-centered care in the intensive care unit. CONCLUSION Further research to explicate the relationships among organizational resources, ethical conflict, burnout, and family-centered care is needed to guide the development of effective interventions that enhance the quality of nursing family care in the intensive care unit.
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Affiliation(s)
| | | | - Jane Leske
- Froedtert & the Medical College of Wisconsin Froedtert Hospital
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Papamichael E, Ioannou M, A Talias M. EMPATHIC-N in a Greek-Cypriot sample: confirming its factorial structure. BMC Health Serv Res 2018; 18:968. [PMID: 30547797 PMCID: PMC6295023 DOI: 10.1186/s12913-018-3793-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/04/2018] [Indexed: 12/03/2022] Open
Abstract
Background Family-centered care has been receiving increased attention during the last decades and health professionals recognize family satisfaction with care as an important health indicator. The Empowerment of Parents in The Intensive Care-Neonatology (EMPATHIC-N) is a newly developed, yet empirically reliable and valid measure for the assessment of parental satisfaction with the care provided by Neonatal Intensive Care Units (NICU). The present study aims to present the Greek version of the EMPATHIC-N and to confirm its factorial structure. Methods The EMPATHIC-N was translated in Greek using a forward-backward translation and was piloted before use. A sample of 256 families receiving intensive care at the NICU of Archbishop Makarios III Public Hospital in Cyprus which is the only NICU in Cyprus, participated in the validation study of the EMPATHIC-N. Confirmatory factor analyses were performed using SPSS and AMOS 24.0. Results The Greek version of the EMPATHIC-N had good psychometric characteristics (Cronbach’s alpha = .87). The CFAs for the separate subscales of professionalism, organization, information, parental involvement and intervention for the EMPATHIC-N showed that all five subscales represented five distinct components of parental satisfaction with care. The CFA of the general instrument supported that a second-order model with a higher-order factor reflecting the organizational structure (professionalism, intervention and organization loaded on this factor) fitted the data best [χ2 (259) = 405.332, p < .001, ΤLI = .887, CFI = .903, RMSEA = .065 (90% CI .058, .073), SRMR = .0597]. Conclusions EMPATHIC-N is a valid and reliable measure for the assessment of parental satisfaction with neonatal care in a Greek-Cypriot context. The organizational dimension of the NICUs is an important component with specific research and clinical implications for the enhancement of parental satisfaction with care. Electronic supplementary material The online version of this article (10.1186/s12913-018-3793-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena Papamichael
- Neonatal Intensive Care Unit, Arch. Makarios III Hospital, 6 Koritsas street, 1474, Strovolos, Nicosia, Cyprus. .,Health Management Unit, Open University of Cyprus, Nicosia, Cyprus.
| | - Myria Ioannou
- Psychology Department, University of Cyprus, Nicosia, Cyprus
| | - Michael A Talias
- Health Management Unit, Open University of Cyprus, Nicosia, Cyprus
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Jeanne Wirpsa M, Emily Johnson R, Bieler J, Boyken L, Pugliese K, Rosencrans E, Murphy P. Interprofessional Models for Shared Decision Making: The Role of the Health Care Chaplain. J Health Care Chaplain 2018; 25:20-44. [DOI: 10.1080/08854726.2018.1501131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Joan Bieler
- Northwestern Memorial Hospital, Chicago, Illinois
| | - Lara Boyken
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen Pugliese
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois
| | - Emily Rosencrans
- Northwestern Medicine Lake Forest Hospital, Lake Forest, Illinois
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Grignoli N, Di Bernardo V, Malacrida R. New perspectives on substituted relational autonomy for shared decision-making in critical care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:260. [PMID: 30309384 PMCID: PMC6182794 DOI: 10.1186/s13054-018-2187-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/12/2018] [Indexed: 11/10/2022]
Abstract
In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives. Whereas patient-centred approaches are widely discussed and fostered, managing communication in complex, especially end-of-life, situations in open intensive care units is still a point of debate and a possible source of conflict and moral distress. In particular, healthcare teams are often sceptical about the growing role of families in shared decision-making and their ability to represent patients’ preferences. New perspectives on substituted relational autonomy are needed for overcoming this climate of suspicion and are discussed through recent literature in the field of medical ethics.
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Affiliation(s)
- Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Via Lugano 4b, CH-6500, Bellinzona, Switzerland. .,Clinical Ethics Commission, Ente Ospedaliero Cantonale, CH-6500, Bellinzona, Switzerland. .,Psychiatry Consultation Liaison Service, Organizzazione Sociopsichiatrica Cantonale, CH-6850, Mendrisio, Switzerland.
| | - Valentina Di Bernardo
- Sasso Corbaro Medical Humanities Foundation, Via Lugano 4b, CH-6500, Bellinzona, Switzerland.,Clinical Ethics Commission, Ente Ospedaliero Cantonale, CH-6500, Bellinzona, Switzerland.,Intensive Care Unit, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, CH-6900, Lugano, Switzerland
| | - Roberto Malacrida
- Sasso Corbaro Medical Humanities Foundation, Via Lugano 4b, CH-6500, Bellinzona, Switzerland
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Fike GC, Smith-Stoner M, Blue DI, Abuatiq AA. Current Trends and Practices of Intensive Care Unit Visitations. J Dr Nurs Pract 2018; 11:169-174. [PMID: 32745026 DOI: 10.1891/2380-9418.11.2.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few topics have existed for decades and created as much of a debate as when discussing appropriate visitation policies for patients. Studies have continued to document the conflicted opinions of nurses to commit to fully open visiting hours for various reasons. Family members are very definite in their desire to be at their loved one's bedside. OBJECTIVE To review the visiting policies of acute care hospitals in California and compare them to the American Association of Critical-Care Nurses recommendations. METHODS This descriptive study collected data from California acute care hospital websites about critical care visiting hours to assess visiting hours and the type, age, and number of visitors. RESULTS Review of 363 hospital websites demonstrated a wide variation in policies when listed. Those that did post their visitation rules had no consistent policies regarding visiting hours or age, relationship, or number of visitors. CONCLUSIONS Hospital visitation policies in California are inconsistent and not evenly enforced. They do not reflect current evidence and practice guidelines. IMPLICATIONS FOR NURSING Ethics require the nurses to advocate for their patient. In this role, nurses need to become proactive in implementing policy changes in their institution based on current evidence and practice guidelines.
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Affiliation(s)
| | | | - Dawn I Blue
- South Dakota State University, Brookings, South Dakota
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What Matters to Persons With Dementia at the End of Life: Perspectives of Proxy Decision Makers. J Hosp Palliat Nurs 2018; 20:478-485. [PMID: 30188442 DOI: 10.1097/njh.0000000000000465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
For substituted decision makers for the growing number of persons with dementia (PWDs), understanding the PWD's values is a prerequisite for making end-of-life (EOL) decisions congruent with the PWD's wishes. The current qualitative study explored PWD health care proxies' perspectives on values that are important to PWDs at end of life and challenges in making EOL decisions that reflect PWDs' values. Semistructured interviews were conducted with 20 PWD proxies, and data were analyzed using the content analysis, an inductive approach to identify themes. Three main themes emerged: (1) what matters to PWDs at end of life, (2) uncertainty about the PWD's current wishes and EOL trajectory poses challenges, and (3) the role of health care professionals' empathic and clear communication. Together, these findings suggest proxies' efforts to understand and respect PWDs' wishes at end of life and communication strategies that health care providers can use to help PWD proxies cope with uncertainty and challenges in EOL decision making.
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Mercadante S, Gregoretti C, Cortegiani A. Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiol 2018; 18:106. [PMID: 30111299 PMCID: PMC6094470 DOI: 10.1186/s12871-018-0574-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/03/2018] [Indexed: 12/15/2022] Open
Abstract
Palliative care is patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering when “curative” therapies are futile. In the Intensive Care Unit (ICU), critically ill patients receive life-sustaining therapies with the goal of restoring or maintaining organ function. Palliative Care in the ICU is a widely discussed topic and it is increasingly applied in clinics. It encompasses symptoms control and end-of-life management, communication with relatives and setting goals of care ensuring dignity in death and decision-making power. However, effective application of Palliative Care in ICU presupposes specific knowledge and training which anesthesiologists and critical care physicians may lack. Moreover, logistic issues such protocols for patients’ selection, application models and triggers for consultation of external experts are still matter of debate. The aim of this review is to provide the anesthesiologists and intensivists an overview of the aims, current evidence and practical advices about the application of palliative care in ICU.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care Unit and Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Via san Lorenzo 312, 90145, Palermo, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy.
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Hoffmann M, Holl AK, Burgsteiner H, Eller P, Pieber TR, Amrein K. Prioritizing information topics for relatives of critically ill patients : Cross-sectional survey among intensive care unit relatives and professionals. Wien Klin Wochenschr 2018; 130:645-652. [PMID: 30094664 PMCID: PMC6244832 DOI: 10.1007/s00508-018-1377-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/23/2018] [Indexed: 11/29/2022]
Abstract
A patient’s admission to an intensive care unit (ICU) has a significant impact on family members and other relatives. In order for them to be able to cope with such a stressful situation, the availability of appropriate understandable and accessible information is crucial. The information asymmetry between relatives and medical professionals may adversely affect satisfaction of relatives and their risk of subsequent anxiety, depression and stress symptoms. The aim of this study was therefore to understand which topics are most important to the relatives of ICU patients and to quantify the perceptions of medical professionals regarding the information needs of relatives. A cross-sectional survey was conducted in 2015. The survey had 42 questions, such as ‘diagnosis’, ‘treatment’, ‘comfort’, ‘family’ and ‘end of life’. In total, the survey was handed out to four different groups. A total of 336 persons answered the survey (26 relatives, 28 ICU physicians, 202 ICU nurses and 80 ICU medical professionals in a closed Facebook© group [Facebook, Menlo Park, California, USA]). Relatives ranked the five most important topics as follows: ‘recent events (crisis)’, ‘my participation’, ‘contamination in hospital’, ‘physical pain’, and ‘probability’. Several significant differences (p<0.001) were detected, for example for the topics fever, medication, recent events (crisis), appointments, relapse, and investigations. Even the topic with the lowest ranking (religion) had a score of 3.15 (min. 1.00, max. 5.00) among relatives. The ICU professionals appear to have divergent opinions regarding the most important topics for ICU relatives as compared to relatives themselves.
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Affiliation(s)
- Magdalena Hoffmann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. .,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria. .,Research Unit for Safety in Health, Medical University of Graz, Graz, Austria.
| | - Anna K Holl
- Department for Psychiatry, University Hospital Graz, Graz, Austria
| | - Harald Burgsteiner
- Institute for Digital Competence and Media Education, University College of Teacher Education Styria, Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Joanneum Research, Graz, Austria
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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