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Tajari M, Ashktorab T, Ebadi A, Zayeri F. Designing and psychometric evaluation of safe nursing care instrument in intensive care units. BMC Nurs 2024; 23:629. [PMID: 39256803 PMCID: PMC11384708 DOI: 10.1186/s12912-024-02322-z] [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: 07/08/2024] [Accepted: 09/03/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Providing safe care in a sensitive and high-risk unit such as the ICU is one of the most crucial tasks for nurses. One way to establish the criteria for safe care is by creating a instrument to assess it. Therefore, this study was conducted with the aim of designing and psychometrically evaluating an instrument for safe nursing care in the ICU. METHODS The current study employed a sequential-exploratory mixed-method approach with two qualitative and quantitative phases. Based on the results of qualitative phase and the literature review, the primary instrument was designed. In the quantitative phase, the designed instrument underwent psychometric evaluation. Face, content and construct validity were assessed. Face validity was assessed by 20 nurses, and content validity was assessed by 26 experts. In the construct validity stage, the sample size for the exploratory factor analysis (EFA) included 300 nurses, and for the confirmatory factor analysis (CFA) included 200 nurses who work full-time in the ICUs of hospitals affiliated with Kermanshah University of Medical Sciences in western Iran. EFA sampling was conducted in three hospitals, encompassing six ICUs, while CFA sampling was carried out in two hospitals, covering four ICUs. Sampling was done using the convenience method. The reliability of the instrument was also assessed. Finally, the interpretability, feasibility, weighting, and scoring of the instrument were evaluated. RESULTS The qualitative phase identified three themes, including professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment). The primary instrument was designed with 107 items rated on a five-point Likert scale. In the quantitative phase, the psychometrics of the instrument were conducted. First, the face and content validity were assessed, and the average scale content validity index (S-CVI) was 0.94. Then, a preliminary test was conducted to assess the initial reliability (α = 0.92) and the correlation of each item with the total score. After completing these steps, the number of items in the instrument was reduced to 52. The results of the EFA explained 58% of the total variance, with 4 factors identified: professional behavior by following guidelines, comprehensive care, accurate documentation, and pressure ulcer care. At the CFA stage, the results of the calculation of indices and goodness of fit showed that the model had a good fit. The reliability of the relative stability by examining the intraclass correlation coefficient (ICC) for the whole instrument in 20 samples was 0.92 with a confidence interval of 0.97 - 0.81. To measure absolute stability and determine the responsiveness of the instrument, the standard error of measurement (SEM) was 4.39 and the minimum detectable change (MDC) was 12.13. CONCLUSION The instrument for safe nursing care in the ICU has favorable psychometric properties.
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Affiliation(s)
- Mozhdeh Tajari
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Tahereh Ashktorab
- Department of Management, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Abbas Ebadi
- Nursing Care Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
| | - Farid Zayeri
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cheon J, Kim H, Kim DH. Healthcare providers' communication experience in the pediatric intensive care unit: a phenomenological study. BMC Health Serv Res 2024; 24:956. [PMID: 39164683 PMCID: PMC11337589 DOI: 10.1186/s12913-024-11394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/02/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Healthcare providers must effectively communicate with other professionals, multidisciplinary teams, and parents of patients in pediatric intensive care units (PICUs) to improve outcomes in children and satisfaction levels of parents. Few studies have focused on healthcare providers' communication experiences, which are crucial for identifying current problems and suggesting future directions. This phenomenological study was conducted to address this gap. METHODS A qualitative study using online and face-to-face interviews was conducted from January to June 2021 by a trained researcher in PICUs of two tertiary hospitals. Participants were five physicians and four registered nurses who worked in the PICUs and had over five years of clinical experience. The interviews were audio recorded with the participant's consent and analyzed by the researchers using Colaizzi's seven-step method. RESULTS Healthcare providers' communication experiences revealed four categories: facing communication difficulties in PICUs, communication relying on individual competencies without established communication methods, positive and negative experiences gained through the communication process, and finding the most effective communication approach. CONCLUSIONS Without adequate support or a systematic training program, healthcare providers often have to overcome communication challenges on their own. Therefore, support and training programs should be developed to facilitate better communication in the future.
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Affiliation(s)
- Jooyoung Cheon
- College of Nursing Science, Sungshin Women's University, 55, Dobong-ro 76ga-gil, Gangbuk- gu, Seoul, Republic of Korea
| | - Hyojin Kim
- College of Nursing, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Dong Hee Kim
- College of Nursing Science, Sungshin Women's University, 55, Dobong-ro 76ga-gil, Gangbuk- gu, Seoul, Republic of Korea.
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Choi MH, Kim HJ, Yoo HJ. Nurses' perspectives about end-of-life care when family presence is restricted during a pandemic: A qualitative study. Aust Crit Care 2024:S1036-7314(24)00201-7. [PMID: 39127604 DOI: 10.1016/j.aucc.2024.06.012] [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: 04/08/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND To prevent the infection from spreading, patients who were dying from COVID-19 were treated in isolation with restricted family access, which differed from existing end-of-life care procedures. This was a significant change that affected the care provided by nurses. OBJECTIVES This study explored nurses' end-of-life care experiences in a limited family visitation setting during the COVID-19 pandemic. METHODS A descriptive qualitative study was conducted. Data were collected through individual, in-depth, semistructured interviews with ten critical care nurses who provided end-of-life care to patients with COVID-19 in South Korea. The data were analysed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used to assess the study's rigour. FINDINGS Three themes were identified: 'Witnessing patients' and families' heartbreak over separation', 'The gaps between the ideals and realities of end-of-life care', and 'Efforts to provide patients with a comfortable final journey'. Nurses realise the importance of their central role in supporting interactions between patients and families during end-of-life care. CONCLUSIONS Family participation, facilitated by nurses' interest and efforts as mediators connecting patients and families, is essential for achieving high-quality care for inpatients facing end of life. This study is significant as it emphasises that the direction of end-of-life care should be family centric, even in a pandemic situation with limited family participation. To improve interaction between patients and families, creating an environment based on family participation that builds trust and strengthens communication is essential. Additionally, hospital support, such as professional education and counselling, should be provided to strengthen nurses' end-of-life care competency.
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Affiliation(s)
- Myung Hui Choi
- Department of Nursing, Dankook University Hospital, Cheonan, Republic of Korea
| | - Hyun Jung Kim
- Department of Nursing, Dankook University Hospital, Cheonan, Republic of Korea
| | - Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, Republic of Korea.
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Kuruppu NR, Tobiano G, Ranse K, Abayadeera A, Chaboyer W. Facilitators, barriers and acceptability of implementing a communication board in Sri Lankan intensive care units: A qualitative descriptive study. Intensive Crit Care Nurs 2024; 83:103708. [PMID: 38643605 DOI: 10.1016/j.iccn.2024.103708] [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: 09/12/2023] [Revised: 03/23/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES To explore patients' and nurses' views of potential facilitators, barriers, and prospective acceptability of implementing a communication board in Sri Lankan intensive care units. DESIGN A qualitative, descriptive study. RESEARCH METHODOLOGY Eight patients who received mechanical ventilation and nine nurses who worked in adult medical and surgical intensive care units were purposively selected. Data were collected via audio-taped, semi-structured, face-to-face interviews in January/February 2023. Interview guide questions were informed by the knowledge-to-action framework and the theoretical framework of acceptability. Data were analysed using inductive and deductive content analysis. The 32-item checklist of the consolidated criteria for reporting qualitative research (COREQ) was used to ensure the quality of reporting. SETTING A 3,000 bed Sri Lankan teaching hospital with 18 intensive care units. FINDINGS Four categories reflecting patients' and nurses' anticipated use of the board were found. The first category described patients' and nurses' 'readiness to use the communication board' and their positive attitudes towards it. The second category focused on the 'potential benefits of the communication board', while the third category emphasised the 'individual patient characteristics' that should be taken into consideration when implementing communication boards. The final category described practical aspects related to 'integrating communication boards into routine practice'. CONCLUSION This study demonstrates communication boards may improve communication between ventilated patients and nurses, and they are acceptable to end users. Adopting these tools may be a pivotal step to enhancing patient-centred care in demanding intensive care settings. IMPLICATIONS FOR CLINICAL PRACTICE An inability to communicate effectively with ventilated intensive care patients creates negative experiences for both patients and nurses. Communication boards may act as a medium to better understand patients' needs during mechanical ventilation.Understanding patients' and nurses' views is beneficial when designing patient-centred communication interventions in intensive care units.
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Affiliation(s)
- Nipuna R Kuruppu
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Department of Nursing, Faculty of Health Sciences, The Open University of Sri Lanka, Nawala, Nugegoda, Sri Lanka.
| | - Georgia Tobiano
- NHMRC CRE in Wiser Wound Care, Griffith University, Queensland, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast Health, Queensland, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Anuja Abayadeera
- Department of Anaesthesiology and Critical Care, Faculty of Medicine, University of Colombo, Sri Lanka and National Hospital of Sri Lanka, Sri Lanka
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; NHMRC CRE in Wiser Wound Care, Griffith University, Queensland, Australia
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Papathanassoglou E, Park T, Punjani N, Pokharel B, Taha M, Hegadoren K. Implementing integrative therapies in adult critical care: Barriers and strategies. Aust Crit Care 2024; 37:563-570. [PMID: 38218673 DOI: 10.1016/j.aucc.2023.11.002] [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: 09/05/2023] [Revised: 11/10/2023] [Accepted: 11/24/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Critically ill patients experience intense physical and psychological stressors in the intensive care unit (ICU). More than half of ICU survivors report overwhelming mental health symptoms after ICU discharge, such as post-traumatic stress symptoms, anxiety, and depression. Relaxation-inducing integrative therapies such as guided imagery, massage, therapeutic touch, music therapy, and spirituality-based healing practices have the potential to promote comfort and relaxation and improve patient outcomes. OBJECTIVES The aim of this study was to explore the attitudes of healthcare professionals towards the implementation of relaxation-inducing integrative therapies in critical care, barriers to implementation, and potential strategies to overcome them. METHODS We conducted seven focus group interviews with 23 critical care clinicians (70% nurses, 17% allied health professionals, 13% physicians). Interviews were audiotaped and transcribed verbatim. Data were thematically analysed using an inductive content analysis approach. FINDINGS Results reveal a constant interplay between mostly positive personal attitudes towards implementation of integrative therapies and the perceived culture and priorities of the unit. The main benefits for critically ill patients as perceived by participants were promotion of comfort, sleep, and coping, increase of trust, and decrease of pain and stress. As for barriers, dominant themes were a perceived lack of evidence, cost, and time constraints and the fear of loss of professional credibility. Participants related nurses' education and training, family involvement, and leadership were seen as main strategies for implementation. CONCLUSIONS The dominant ICU culture needs to be considered when implementing integrative therapies. Education, access to evidence, and role modelling are proposed as means to shift the ICU culture towards utilisation of integrative therapies in critical care.
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Soyaslan BD, Alıncak G, Ilkaz N, Zengin H. Longing for a Voice: A Qualitative Study. J Hosp Palliat Nurs 2024; 26:E92-E97. [PMID: 38421199 DOI: 10.1097/njh.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Tracheostomy involves a challenging care process in which both patients and caregivers have difficulty communicating. Loss of speaking ability negatively affects caregivers as well as patients. The objective of this study was to examine the experiences of caregivers of patients with tracheostomy during care and after the first vocal exercise. This is a qualitative interview study using in-depth interviews. We used Colaizzi's method of data analysis. The interviews were carried out with 17 caregivers from March to July 2023. Two main themes were identified: the communication process and the first time hearing the patient's voice. In addition, communication techniques, difficulty in communication, providing motivation, and emotions were considered as subthemes. A better quality of care can be provided by understanding the experiences of caregivers of patients with tracheostomy, by sharing feelings and thoughts, and by using patient-specific communication methods.
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Abbaszadeh R, Ahmadi F, Khoobi M, Kazemnejad A, Vaismoradi M. Contributors to fatigue among nurses working in critical care units: A qualitative study. Nurs Crit Care 2024. [PMID: 38760950 DOI: 10.1111/nicc.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Fatigue is a growing concern among nurses who provide care to unstable and critically ill patients in critical care wards. It has various negative consequences for both nurses and patients. AIM To explore and describe contributors to fatigue among nurses working in critical care units. STUDY DESIGN A qualitative content analysis. RESULTS Participants were 21 nurses chosen using purposeful sampling. They were working in different critical care units at different hospitals in nine urban areas of Iran. Semi-structured interviews were used to collect data, and conventional content analysis was used to develop categories and subcategories. The analysis of data on the nurses' perspectives and experiences led to developing nine categories as contributors to fatigue: 'compassion fatigue', 'extensive network of interactions', 'sound and alarm fatigue', 'psychological tensions', 'managerial and organizational tensions', 'lack of motivation and incentives', 'individual characteristics of nurses', 'physical and mental pressure', and requirements of special care and situational complexity'. CONCLUSIONS Understanding the factors that influence the experience of fatigue among nurses working in critical care units is essential for maintaining a reliable and high-quality health care environment within health care facilities. RELEVANCE TO CLINICAL PRACTICE The experience of fatigue by critical care nurses can increase the possibility of practice errors, reduce patient safety and quality of care, and enhance staff burnout and turnover. Proactive policies should be formulated to assess nurses' fatigue levels and implement strategies for effective fatigue management. This approach aims to enhance both patient safety and job satisfaction in the workplace.
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Affiliation(s)
- Reyhaneh Abbaszadeh
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fazlollah Ahmadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mitra Khoobi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, New South Wales, Australia
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Reifarth E, Böll B, Kochanek M, Garcia Borrega J. Communication strategies for expressing empathy during family-clinician conversations in the intensive care unit: A mixed methods study. Intensive Crit Care Nurs 2024; 81:103601. [PMID: 38101211 DOI: 10.1016/j.iccn.2023.103601] [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: 09/04/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES To explore communication strategies intensive care clinicians and patients' family members prefer for expressing empathy during family-clinician conversations. RESEARCH METHODOLOGY/DESIGN Mixed-methods survey study. SETTING Two medical ICUs of a German academic tertiary care hospital. MAIN OUTCOME MEASURES Using a self-developed online survey with closed and open-ended questions with free-text options, the participants' preferences of communication strategies for expressing empathy were investigated. Quantifiable similarities and differences were determined by statistical analysis. Qualitative themes were derived at by directed content analysis. FINDINGS The responses of 94 family members, 42 nurses, and 28 physicians were analysed (response rate: 45.3 %). Four communication strategies were deduced: (1) reassuring the families that the intensive care unit team will not abandon neither them nor the patient, (2) acknowledging emotions and offering support, (3) saying that the families are welcome and cared for in the intensive care unit, (4) providing understandable information. In comparison, the families considered an expression of nonabandonment as more empathic than the physicians did (p =.031,r = 0.240), and those expressions focussing solely on the family members' well-being (p =.012,r = 0.228) or comprising evaluative wording ("good", "normal") (p =.017,r = 0.242) as less empathic than the nurses did. Unanimously advocated nonverbal communication strategies included to listen attentively and to avoid interrupting as well as being approachable and honest. CONCLUSION The participants' preferences supported expert recommendations and highlighted that it is not only important what the clinicians say but also how they say it. Further research is needed to elucidate ways of successfully expressing empathy during family-clinician conversations in the intensive care unit. IMPLICATIONS FOR CLINICAL PRACTICE Intensive care unit clinicians are encouraged to practice active listening and to express their caring and nonabandonment. It is further suggested to reflect on and adjust pertinent nonverbal behaviours and relational aspects of their communication, as applicable.
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Affiliation(s)
- Eyleen Reifarth
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany.
| | - Boris Böll
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Jorge Garcia Borrega
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
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Gentile MN, Irvine AD, King AM, Hembrom AS, Guruswamy KS, Palivela NE, Langton-Frost N, McElroy CR, Pandian V. Enhancing Communication in Critically Ill Patients with a Tracheostomy: A Systematic Review of Evidence-Based Interventions and Outcomes. TRACHEOSTOMY (WARRENVILLE, ILL.) 2024; 1:26-41. [PMID: 39253605 PMCID: PMC11382609 DOI: 10.62905/001c.115440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background Tracheostomy, a common procedure performed in intensive care units (ICU), is associated with communication impairment and affects patient well-being. While prior research has focused on physiological care, there is a need to address communication needs and quality of life (QOL). We aimed to evaluate how different types of communication devices affect QOL, speech intelligibility, voice quality, time to significant events, clinical response and tolerance, and healthcare utilization in patients undergoing tracheostomy. Methods Following PRISMA guidelines, a systematic review was conducted to assess studies from 2016 onwards. Eligible studies included adult ICU patients with a tracheostomy, comparing different types of communication devices. Data were extracted and synthesized to evaluate QOL, speech intelligibility, voice quality, time to significant events (initial communication device use, oral intake, decannulation), clinical response and tolerance, and healthcare utilization and facilitators/barriers to device implementation. Results Among 9,228 studies screened, 8 were included in the review. Various communication devices were employed, comprising both tracheostomy types and speaking valves, highlighting the multifaceted nature of interventions. Quality of life improvements were observed with voice restoration interventions, but challenges such as speech intelligibility impairments were noted. The median time for initial communication device usage post-intervention was 11.4 ± 5.56 days. The median duration of speech tolerance ranged between 30-60 minutes to 2-3 hours across different studies. Complications such as air trapping or breathing difficulties were reported in 15% of cases. Additionally, the median ICU length of stay post-intervention was 36.5 days. Key facilitators for device implementation included early intervention, while barriers ranged from service variability to physical intolerance issues. Conclusion Findings demonstrate that various types of communication devices can significantly enhance the quality of life, speech intelligibility, and voice quality for patients undergoing tracheostomy, aligning with the desired outcomes of improved clinical response and reduced healthcare utilization. The identification of facilitators and barriers to device implementation further informs clinical practice, suggesting a tailored, patient-centered approach is crucial for optimizing the benefits of communication devices in this population.
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Affiliation(s)
- Mary N Gentile
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
| | - Annalise D Irvine
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
| | - Annamarie M King
- Department of Physical Medicine and Rehabilitation, Indiana University Health
| | | | | | | | | | - Colleen R McElroy
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
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Lindig A, Mielke K, Frerichs W, Cöllen K, Kriston L, Härter M, Scholl I. Evaluation of a patient-centered communication skills training for nurses (KOMPAT): study protocol of a randomized controlled trial. BMC Nurs 2024; 23:2. [PMID: 38163904 PMCID: PMC10759369 DOI: 10.1186/s12912-023-01660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND To ensure high quality of nurses' communication as part of patient-centered care, training of communication skills is essential. Previous studies indicate that communication skills trainings can improve communication skills of nurses and have a positive effect on emotional and psychological burden. However, most show methodological limitations, are not specifically developed for nurses or were developed for oncological setting only. METHODS This study aims to evaluate the effectiveness of a needs-based communication skills training for nursing professionals and to derive indications for future implementation. A two-armed randomized controlled trial including components from both effectiveness and implementation research will be applied. Additionally, a comprehensive process evaluation will be carried out to derive indications for future implementation. Nurses (n=180) of a university medical center in Germany will be randomized to intervention or waitlist-control group. The intervention was developed based on the wishes and needs of nurses, previously assessed via interviews and focus groups. Outcomes to measure effectiveness were selected based on Kirkpatrick's four levels of training evaluation and will be assessed at baseline, post-training and at 4-weeks follow-up. Primary outcome will be nurses' self-reported self-efficacy regarding communication skills. Secondary outcomes include nurses' communication skills assessed via standardized patient assessment, knowledge about patient-centered communication, mental and work-related burden, and participants' satisfaction with training. DISCUSSION To our knowledge, this is the first study systematically evaluating the effectiveness of a patient-centered communication skills training for nursing professionals in Germany. Results will yield insight whether a needs-based intervention can improve nurses' self-efficacy regarding communication skills and other secondary outcomes. TRIAL REGISTRATION Clinical trial registration number: NCT05700929, trial register: ClinicalTrials.gov (date of registration: 16 November 2022).
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Affiliation(s)
- Anja Lindig
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Center for Health Care Research and Public Health, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kendra Mielke
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- Center for Health Care Research and Public Health, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Wiebke Frerichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Center for Health Care Research and Public Health, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Katja Cöllen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Center for Health Care Research and Public Health, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Center for Health Care Research and Public Health, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Center for Health Care Research and Public Health, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Center for Health Care Research and Public Health, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Holm A, Dreyer P. Nurses' experiences of the phenomenon 'isolation communication'. Nurs Crit Care 2023; 28:885-892. [PMID: 36156341 DOI: 10.1111/nicc.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/12/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID-19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes. AIM To explore nurses' experiences of communicating while wearing PPE during COVID-19 isolation precautions in the ICU. STUDY DESIGN A qualitative study within the phenomenological-hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur-inspired text interpretation method. FINDINGS Three themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation. CONCLUSION The analysis revealed a phenomenon that can be described as 'isolation communication'. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure. RELEVANCE TO CLINICAL PRACTICE As our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.
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Affiliation(s)
- Anna Holm
- Aarhus University Hospital, Aarhus, Denmark
| | - Pia Dreyer
- Aarhus University Hospital, Aarhus, Denmark
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12
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Twose P, Terblanche E, Jones U, Firshman P, Merriweather J, Rock C, Wallace S. Protected therapy services for critical care: A subanalysis of the UK-wide workforce survey. Aust Crit Care 2023; 36:821-827. [PMID: 36604266 DOI: 10.1016/j.aucc.2022.11.011] [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: 07/19/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The existing United Kingdom (UK) allied health professional (AHP) workforce in critical care does not meet national standards, with widespread variation in the source of funding, service availability, and regularity of input. OBJECTIVES The aim of this subanalysis was to determine the impact of protected services on the involvement of AHPs on direct and nondirect aspects of patient care. METHODS This is a subanalysis of the previously published AHPs in critical care UK-wide workforce survey, an observational study using online surveys distributed to 245 critical care units across the UK. RESULTS/FINDINGS Services with protected funding provided more daily input within critical care. This was most apparent for occupational therapy where daily input varied from 82.1% of units with protected services compared to just 10.3% in those without (p < 0.001). For all professions, most notably occupational therapy and speech and language therapy, protected services increased the regularity in which specific interventions were completed and had impact on involvement in nonclinical aspects of care including involved in multidisciplinary team meetings, clinical governance, and research. CONCLUSIONS The absence of protected AHP services reduces compliance with national standards for therapy workforce. Based on these findings, UK and international critical care guidelines should promote protected AHP services for critical care.
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Affiliation(s)
- Paul Twose
- School of Healthcare Sciences, Cardiff University, UK; Physiotherapy Department, Cardiff and Vale UHB, UK.
| | - Ella Terblanche
- Kings College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London SE1 8WA, UK.
| | - Una Jones
- School of Healthcare Sciences, Cardiff University, UK.
| | | | | | - Claire Rock
- Mid and South Essex NHS Foundation Trust, UK.
| | - Sarah Wallace
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK.
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13
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Leong EL, Chew CC, Ang JY, Lojikip SL, Devesahayam PR, Foong KW. The needs and experiences of critically ill patients and family members in intensive care unit of a tertiary hospital in Malaysia: a qualitative study. BMC Health Serv Res 2023; 23:627. [PMID: 37312146 DOI: 10.1186/s12913-023-09660-9] [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: 01/03/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Admission to an intensive care unit (ICU) is a stressful experience for patients and their family members. While the focus of management is primarily on medical care, there can be other areas which are overlooked. The purpose of this study was to investigate the needs and experiences of ICU patients and family members. METHOD This qualitative study involved four trained researchers conducting in-depth interviews (IDI) based on a semi-structured interview guide. The participants were ICU patients and family members. All IDIs were audio-recorded and transcribed verbatim. Four researchers independently analyzed the data via thematic analysis with the aid of QDA Miner Lite®. The themes and subthemes were generated and confirmed by literature and expert opinion. RESULTS Six IDIs were conducted with three patients and three family members, whose ages ranged from 31 to 64 years old. One pair of participants consisted of a patient and his respective family member, while the other four participants did not have a familial relationship with each other. Three main themes emerged from the analysis: (I) critical care services; (II) physical spaces; and (III) monitoring technology. Medical, psychological, physical, and social needs for critical care services were expressed by both patients and family members. Patients' needs in clinical spaces were highlighted as a conducive ICU environment with ambient temperature and controlled noise levels. In non-clinical spaces, family members expressed a need for more chairs in the waiting area. Participants expressed the need for call bells as well as patients' negative perceptions of medical equipment alarms in the ICU when it pertained to monitoring technology. CONCLUSION This study provides an in-depth view at the needs and experiences of ICU patients and family members who have a variety of unmet needs. This understanding is critical for guiding ICU personnel and stakeholders in their efforts to humanize ICU care.
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Affiliation(s)
- E-Li Leong
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia.
| | - Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia
| | - Ju-Ying Ang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia
| | - Sharon-Linus Lojikip
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia
| | - Philip-Rajan Devesahayam
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia
- Otolaryngology Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Kit-Weng Foong
- Anaesthesiology and Intensive Care Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
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14
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Vázquez-Calatayud M, González-Luis H. The communication 360° in the intensive care units: Nurses' challenges and opportunities. ENFERMERIA INTENSIVA 2023; 34:57-59. [PMID: 37225619 DOI: 10.1016/j.enfie.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/22/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Mónica Vázquez-Calatayud
- Clínica Universidad de Navarra. Desarrollo Profesional e Investigación en Enfermería Universidad de Navarra, Grupo de investigación ICCP-UNAV, Innovación para un Cuidado Centrado en la Persona. IdisNA, Instituto de Investigación Sanitaria de Navarra, Spain.
| | - Hildegart González-Luis
- Facultad de Enfermería de la Universidad de Navarra, Departamento de Enfermería Comunitaria y Materno Infantil. Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, USA. Universidad de Navarra, Grupo de investigación ICCP-UNAV, Innovación para un Cuidado Centrado en la Persona. IdisNA, Instituto de Investigación Sanitaria de Navarra, Spain. https://twitter.com/hildegartglez
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15
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Yoo HJ, Shim J. The impact of family care visitation programme on patients and caregivers in the intensive care unit: A mixed methods study. J Clin Nurs 2023. [PMID: 36876455 DOI: 10.1111/jocn.16650] [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: 07/24/2022] [Revised: 01/12/2023] [Accepted: 01/26/2023] [Indexed: 03/07/2023]
Abstract
AIMS To track changes in the haemodynamic and respiratory indicators of patients and evaluate families' caring experiences via the visitation programme in the intensive care unit (ICU). BACKGROUND Although most people recognise the importance of family care visitation programme in the ICU, objective research results on the effect on patients and caregivers are still insufficient. DESIGN Mixed methods. METHODS In this a quasi-experimental investigation and qualitative study, after executing the programme with families of ICU patients in a general hospital in South Korea from June to July 2019, changes in haemodynamic and respiratory indicators for control (n = 28) and experimental groups (n = 28) were analysed; the experimental group families' experiences were analysed through in-depth interviews; the qualitative study's reporting rigour was checked against the COREQ guidelines and TREND checklist for a quasi-experimental study. Qualitative and quantitative data were examined using content analysis and repeated-measures analysis of variance, respectively. RESULTS There was a significant change in systolic and diastolic blood pressure in the haemodynamic indicator, and the respiratory indicator in both groups increased slightly over time and then gradually stabilised; there were no significant differences or interactions between groups regarding time of systolic blood pressure. The respiratory rate significantly decreased only in the experimental group. There was a significant increase in oxygen saturation over time, as well as interactions between time and group and between groups. Four themes were extracted from families' experiences. CONCLUSION The haemodynamic and respiratory indicators of the group using patient- and family-centred care (PFCC) showed a stable effect on critically ill patients, which increased families' satisfaction. In future, interventions should encourage family participation in the ICU for successful PFCC. RELEVANCE TO CLINICAL PRACTICE The findings provided evidence for the importance of PFCC through changes in objective haemodynamic and respiratory indicators.
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Affiliation(s)
- Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, South Korea
| | - JaeLan Shim
- College of Nursing, Dongguk University, Gyeongju, South Korea
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16
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Wallace S, McGowan S, Sutt AL. Benefits and options for voice restoration in mechanically ventilated intensive care unit patients with a tracheostomy. J Intensive Care Soc 2023; 24:104-111. [PMID: 36874291 PMCID: PMC9975806 DOI: 10.1177/17511437221113162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Communication difficulties and their effects on patients who are mechanically ventilated are commonly reported and well described. The possibility of restoring speech for patients has obvious benefits, not only for meeting patient's immediate needs, but for helping them to re-engage in relationships and participate meaningfully in their recovery and rehabilitation. This opinion piece by a group of United Kingdom (UK) based Speech and Language Therapy experts working in critical care describes the various ways by which a patient's own voice can be restored. Common barriers to using different techniques and potential solutions are explored. We therefore hope that this will encourage intensive care unit (ICU) multi-disciplinary teams to advocate and facilitate early verbal communication in these patients.
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Affiliation(s)
- Sarah Wallace
- Department of Speech Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK.,Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Sue McGowan
- Therapy Services, National Hospital for Neurology and Neurosurgery, UK
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,Speech and Language Therapy, The Royal London Hospital, UK
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17
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Zaga CJ, Freeman-Sanderson A, Happ MB, Hoit JD, McGrath BA, Pandian V, Quraishi-Akhtar T, Rose L, Sutt AL, Tuinman PR, Wallace S, Bellomo R, Berney S, Vogel AP. Defining effective communication for critically ill patients with an artificial airway: An international multi-professional consensus. Intensive Crit Care Nurs 2023; 76:103393. [PMID: 36706499 DOI: 10.1016/j.iccn.2023.103393] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To define effective communication and identify its key elements specific to critically ill patients with an artificial airway. DESIGN A modified Consensus Development Panel methodology. SETTING International video-conferences. MAIN OUTCOME MEASURES Definition of effective communication and it's key elements. RESULTS Eight experts across four international regions and three professions agreed to form the Consensus Development Panel together with a Chair and one person with lived experience who reviewed the outputs prior to finalisation. "Communication for critically ill adult patients with an artificial airway (endotracheal or tracheostomy tube) is defined as the degree in which a patient can initiate, impart, receive, and understand information, and can range from an ineffective to effective exchange of basic to complex information between the patient and the communication partner(s). Effective communication encompasses seven key elements including: comprehension, quantity, rate, effort, duration, independence, and satisfaction. In critically ill adults, communication is impacted by factors including medical, physical and cognitive status, delirium, fatigue, emotional status, the communication partner and the nature of the ICU environment (e.g., staff wearing personal protective equipment, noisy equipment, bright lights)." The panel agreed that communication occurs on a continuum from ineffective to effective for basic and complex communication. CONCLUSION We developed a definition and list of key elements which constitute effective communication for critically ill patients with an artificial airway. These can be used as the basis of standard terminology to support future research on the development of communication-related outcome measurement tools in this population. IMPLICATIONS FOR CLINICAL PRACTICE This study provides international multi-professional consensus terminology and a definition of effective communication which can be used in clinical practice. This standard definition and key elements of effective communication can be included in our clinical impressions of patient communication, and be used in discussion with the patient themselves, their families and the multi-professional team, to guide care, goal development and intervention.
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Affiliation(s)
- Charissa J Zaga
- Department of Speech Pathology, Division of Allied Health, Austin Health, Melbourne, Australia; Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia; Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Institute of Breathing and Sleep, Austin Health, Melbourne, Australia.
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mary Beth Happ
- Center for Healthy Aging, Self-Management & Complex Care, The Ohio State University College of Nursing, United States of America
| | - Jeannette D Hoit
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ, United States of America
| | - Brendan A McGrath
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, United Kingdom; Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Vinciya Pandian
- Department of Nursing Faculty, Johns Hopkins University, Baltimore, MD, United States of America; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - Sarah Wallace
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, United Kingdom; Department of Speech Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Adam P Vogel
- Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia; Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tübingen, Germany; Redenlab, Melbourne, Australia
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18
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Emergency nurses' communication experiences with patients and their families during the COVID-19 pandemic: A qualitative study. Int Emerg Nurs 2023; 66:101240. [PMID: 36584657 PMCID: PMC9676159 DOI: 10.1016/j.ienj.2022.101240] [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] [Received: 07/05/2022] [Revised: 10/22/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the emergency department, essential information is verified primarily through communication with patients and families. Thus, an in-depth understanding of emergency nurses' communication experiences with patients is required to facilitate the provision of effective therapeutic care. OBJECTIVE To analyze emergency nurses' communication experiences with patients and their families. METHODS A qualitative descriptive design was used. Interviews were conducted with 15 nurses between 2021 and 2022. Thematic analysis was carried out. This study was conducted in accordance with the consolidated criteria for reporting qualitative studies (COREQ). RESULTS Three themes were identified: transformation of communication approaches due to COVID-19, obstacles in therapeutic communication, and continuous endeavors for improved communication. CONCLUSION Emergency nurses experienced various barriers in communication with patients and their families, which were exacerbated by COVID-19. Nevertheless, nurses attempted to enhance their communication skills. Organizational support is pertinent to establish effective communication strategies.
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19
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Dees ML, Carpenter JS, Longtin K. Communication Between Registered Nurses and Family Members of Intensive Care Unit Patients. Crit Care Nurse 2022; 42:25-34. [DOI: 10.4037/ccn2022913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background
Effective communication between intensive care unit patients and their families and nurses promotes relationship-centered care and improves nurses’ ability to meet patient and family needs. However, communication with these patients is challenging because of their critical illness. Families often become surrogate decision makers for adult intensive care unit patients.
Objective
To systematically assess available evidence on communication between adult intensive care unit patients and their families and nurses as the initial step in developing nursing strategies to strengthen communication skills.
Methods
In this integrative review, the method of Whittemore and Knafl was used to synthesize findings from qualitative and quantitative (descriptive and experimental) research.
Results
The review revealed a variety of research designs, measurement tools, and types of interventions. The qualitative findings suggest that nurses can strengthen relationship-centered care by regularly updating patients’ families and providing information that can assist with decision-making. The quantitative findings suggest that nurses should be mindful of family members’ needs for assurance, comfort, and support. Providing information on patient status can help alleviate family concerns.
Conclusions
Improved communication between patients and families and intensive care unit nurses is essential to strengthen relationship-centered care. Additional research is needed to better understand the communication needs of adult patients and their families in the intensive care unit.
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Affiliation(s)
- Mandy L. Dees
- Mandy L. Dees is a doctoral student, Indiana University School of Nursing, Indianapolis, Indiana
| | - Janet S. Carpenter
- Janet S. Carpenter is Distinguished Professor and Audrey Geisel Endowed Chair in Innovation, Indiana University School of Nursing
| | - Krista Longtin
- Krista Longtin is an associate professor, Indiana University School of Liberal Arts, and assistant dean, Indiana University School of Medicine, Indianapolis, Indiana
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20
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Wanko Keutchafo EL, Kerr J, Baloyi OB. A Model for Effective Nonverbal Communication between Nurses and Older Patients: A Grounded Theory Inquiry. Healthcare (Basel) 2022; 10:2119. [PMID: 36360461 PMCID: PMC9690069 DOI: 10.3390/healthcare10112119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 08/24/2023] Open
Abstract
Nonverbal communication is an inevitable art to be effectively mastered by nurses. Nurse nonverbal communication has many benefits when it is effective. For instance, nonverbal communication is important to convey affective and emotional information, and demonstrate respect for and build therapeutic relationships with older patients. As the older population is growing fast worldwide, effective nonverbal communication with older patients is an essential skill for nurses and will improve patients' satisfaction and the quality of care. Therefore, this article presents a model to guide effective nonverbal communication between nurses and older patients. A Grounded Theory approach guided the study. Data were collected between July 2018 and January 2020 through overt participant observations and individual interviews. Purposive and theoretical sampling were used to select 13 clinically experienced nurses, 4 nursing students, and 8 older adults. Data analysis encompassed open coding, axial coding, and selective coding. The results showed that effective nonverbal communication emerged as the co-phenomenon hinged within context and/or environment and is influenced by certain factors. This model, which is in support of person-centered communication and care, advocates for effective nonverbal communication between nurses and older patients.
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Affiliation(s)
- Esther L. Wanko Keutchafo
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
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21
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Akroute AR, Brinchmann BS, Hovland A, Fredriksen STD. ICU nurses´ lived experience of caring for adult patients with a tracheostomy in ICU: a phenomenological-hermeneutic study. BMC Nurs 2022; 21:214. [PMID: 35927677 PMCID: PMC9354289 DOI: 10.1186/s12912-022-01005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The care of adult patients with a tracheostomy in intensive care unit is complex, challenging and requires skilled intensive care unit nurses. ICU nurses’ live experience is scarcely known. This study aimed to describe the lived experience of intensive care unit nurses of caring for adult patients with a tracheostomy in intensive care unit. Methods This study employs a qualitative design. In-depth interviews were conducted with a purposive sampling of 6 intensive care unit nurses from a medical-surgical ICU of a university hospital in Norway who were interviewed. Data was analyzed and interpreted using a phenomenological-hermeneutic approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The interpretation yielded the following themes and subthemes: 1) theme: ‘challenges of caring for patients with a tracheostomy’ consisted of the sub-themes: ‘difficult to communicate/interpret and understand the patient’s different forms of expression’, ‘complicated professional assessments’, ‘caring with patience’, and ‘collaborating with patient regarding challenges. 2) theme: ‘the satisfaction from providing care to patients with a tracheostomy’ consisted of the sub-themes: ‘working with intensive care patients is instructive’ and ‘importance to motivate’. Conclusions ICU nurses experienced ambivalent feelings while caring for adult patients with a tracheostomy in ICU. They perceived caring as demanding owing to communication and collaboration at the same time, they experienced satisfaction while they strived to provide proper care and motivation. The identified challenges would lead to further improvement in nurses’ experiences and, in turn, the quality-of-care for patients with a tracheostomy. Awareness of these challenges is crucial to understand the need for an effective communication strategy to improve the quality and safety of adult patients with tracheostomy in ICU.
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Affiliation(s)
- Abder Rahim Akroute
- Department of Anesthesia and Intensive Care Medicine, Nordland Hospital, N-8049, Bodø, Norway.
| | - Berit Støre Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, 8026, Bodø, Norway.,Nordland Hospital, 8076, Bodø, Norway
| | - Anders Hovland
- Department of Cardiology, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Sven-Tore Dreyer Fredriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,, Campus Harstad, Havnegata 5, 9480, Harstad, Norway.,Huntington network, Knorrebakken 2, 9411, Harstad, Norway
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22
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Shin S, Yoo HJ. Frontline nurses' caring experiences in COVID-19 units: A qualitative study. J Nurs Manag 2022; 30:1087-1095. [PMID: 35338532 PMCID: PMC9115182 DOI: 10.1111/jonm.13607] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
Aim Exploring nurses' caring and communication experiences in COVID‐19 units. Background Frontline nurses play a critical role in providing 24‐h bedside nursing care to COVID‐19 patients. An in‐depth understanding of frontline nurses' lived experiences is necessary to establish appropriate nursing strategies during crises, such as the COVID‐19 pandemic. Methods Qualitative descriptive design with content analysis. Results Fifteen nurses were interviewed, and three themes were identified: central role of therapeutic communication, compassion that deepens naturally and expansion of professionalism in nursing. Conclusion The nurses proactively provided care for COVID‐19 patients, and they acknowledged and accepted their roles in protecting the lives and ensuring the health of their patients daily. The nurses' experiences in COVID‐19 units served as an opportunity for ruminating and rediscovering the meaning of nursing. Implications for Nursing Management Hospital policymakers and nurse managers should strive to resolve the communication‐related challenges faced by nurses. Standardizing and implementing effective communication strategies should be considered in nursing management.
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Affiliation(s)
| | - Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, South Korea
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23
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Díaz-Agea JL, Orcajada-Muñoz I, Leal-Costa C, Adánez-Martínez MG, De Souza Oliveira AC, Rojo-Rojo A. How Did the Pandemic Affect Communication in Clinical Settings? A Qualitative Study with Critical and Emergency Care Nurses. Healthcare (Basel) 2022; 10:373. [PMID: 35206987 PMCID: PMC8872094 DOI: 10.3390/healthcare10020373] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 01/10/2023] Open
Abstract
The objective of the present study was to determine the subjective impact of the pandemic due to COVID-19 on communication, as perceived by nurses working at emergency services and Intensive Care Units at various hospitals in the Region of Murcia (Spain). A qualitative study was conducted based on the content analysis of 12 semi-structured individual interviews. The participant recruitment process was performed through a snowball sampling technique. Four main dimensions, eleven categories, and two sub-categories were obtained: (1) communication (communicative expressions, both verbal and non-verbal-, and limitations); (2) emotional aspects (positive, negative); (3) overload (first wave, second wave, and third wave); and (4) relationships (health professionals-patients, healthcare professionals, patients-family, and family-health professionals). The main findings of the study show that communication was slightly affected during the pandemic, especially the non-verbal kind, with verbal communication maintained and, in some occasions, strengthened. The lack of training in communication skills and its influence on the management of difficult periods was another important finding. Communication in general deteriorated during the pandemic, especially during the initial waves. Non-verbal communication was more affected due to the use of Personal Protective Equipment and the initial fear of infection, with this finding strongly observed in departments such as emergencies or critical care. The nurses who were interviewed underlined negative emotional aspects associated with a deficit in communication. The positive aspects described were associated with the creation of mutual support spaces and the group cohesion of the work teams during the pandemic. As an implication for current and future clinical practice, we recommend a coordinated institutional response to mitigate the potential emotional effects on workers by designing appropriate communication and emotional expression protocols.
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Affiliation(s)
- José Luis Díaz-Agea
- Faculty of Nursing, Universidad Católica de Murcia, 30107 Guadalupe, Spain; (J.L.D.-A.); (I.O.-M.); (A.C.D.S.O.); (A.R.-R.)
| | - Irene Orcajada-Muñoz
- Faculty of Nursing, Universidad Católica de Murcia, 30107 Guadalupe, Spain; (J.L.D.-A.); (I.O.-M.); (A.C.D.S.O.); (A.R.-R.)
| | - César Leal-Costa
- Faculty of Nursing, Universidad de Murcia, 30120 El Palmar, Spain
| | | | | | - Andrés Rojo-Rojo
- Faculty of Nursing, Universidad Católica de Murcia, 30107 Guadalupe, Spain; (J.L.D.-A.); (I.O.-M.); (A.C.D.S.O.); (A.R.-R.)
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24
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Rahul, Kumar A, Verma A, Sanjeev OP, Singh RK, Ghatak T, Nath A. A questionnaire-based study on quality and adequacy of clinical communication between physician and family members of admitted Covid-19 patients. PATIENT EDUCATION AND COUNSELING 2022; 105:304-310. [PMID: 34625320 PMCID: PMC8445776 DOI: 10.1016/j.pec.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 03/30/2024]
Abstract
OBJECTIVE To assess adequacy of present means of clinical communication between physicians and (Covid-19) patients' family members, to analyse their perspectives and recommend felicitous practices for virtual conversation during ongoing pandemic. METHODS Cross-sectional questionnaire-based (20 questions) anonymous online survey was conducted including patient's relatives (Group-1) and treating physicians (Group-2), through Google Forms. RESULTS Response Rate was 82.5%. Group-1 and Group-2 included 155 and 204 respondents respectively. Group-1 preferred update by resident doctors (39%), twice a day (41.9%), daily case-summaries (80%) and hand-written document/electronic messages (53%,31%) as consent. Whereas Group-2 favored update by senior consultants (63%), daily one appraisal (55.9%) and scanned copies of hand written consent (81%) before high-risk procedures. The groups broadly agreed on the desired duration for a fruitful discussion (5-10 min) and designating one responsible person from the family for daily appraisal. CONCLUSION Use of modern techniques/technologies of communication (voice/video calls, texts) during the ongoing pandemic is acceptable to majority. PRACTICE IMPLICATIONS Study proposes a senior physician should communicate to a designated responsible family member at-least once a day for stable and twice a day for critical covid patients (more if patient's health condition changes), either by voice or video calls for 5-10 min.
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Affiliation(s)
- Rahul
- Department of Surgical Gastroenterology, C, Block, SGPGI (MS), Lucknow 226014, India.
| | - Anup Kumar
- Department of Biostatistics and Health Informatics, H, Block, SGPGI (MS), Lucknow 226014, India.
| | - Alka Verma
- Department of Emergency Medicine, SGPGI (MS), Lucknow 226014, India.
| | - Om Prakash Sanjeev
- Department of Emergency Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
| | | | - Tanmoy Ghatak
- Department of Emergency Medicine, SGPGI (MS), Lucknow 226014, India.
| | - Alok Nath
- Department of Pulmonology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, PMSSY Block, SGPGI, Lucknow 226014, India
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Goldberg MA, Hochberg LR, Carpenter D, Walz JM. Development of a Manually Operated Communication System (MOCS) for patients in intensive care units. Augment Altern Commun 2022; 37:261-273. [PMID: 35023431 DOI: 10.1080/07434618.2021.2016958] [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: 10/19/2022] Open
Abstract
Nonvocal alert patients in the intensive care unit (ICU) setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. Innovation of a hand-operated non-touchscreen communication system for nonvocal ICU patients was guided by design concepts including speech output, simplicity, and flexibility. A novel communication tool, the Manually Operated Communication System (MOCS), was developed for use in intensive care settings with patients unable to speak. MOCS is a speech-output technology designed for patients with manual dexterity impairments preventing legible writing. MOCS may have the potential to improve communication for nonvocal patients with limited manual dexterity.
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Affiliation(s)
- Miriam A Goldberg
- MD/PhD Program, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Leigh R Hochberg
- Carney Institute for Brain Science and School of Engineering, Brown University, Providence, RI, USA.,Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Cambridge, MA, USA.,Rehabilitation R&D Service, US Department of Veterans Affairs, VA RR&D Center for Neurorestoration and Neurotechnology, Providence, RI, USA
| | - Dawn Carpenter
- Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester, MA, USA.,Surgical/Trauma Critical Care, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - J Matthias Walz
- Department of Anesthesiology & Perioperative Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Chen C, Sullivan SS, Lorenz RA, Wittenberg E, Li CS, Chang YP. COMFORT communication in the ICU: Pilot test of a nurse-led communication intervention for surrogates. J Clin Nurs 2021; 31:3076-3088. [PMID: 34811825 DOI: 10.1111/jocn.16132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 12/28/2022]
Abstract
AIM This study was designed to investigate the feasibility, acceptability, and preliminary efficacy of a nurse-led communication intervention among surrogates in the intensive care unit (ICU) guided by the COMFORT (Connect; Options; Making meaning; Family caregivers; Openings; Relating; Team) communication model. BACKGROUND As frontline communicators, nurses experience communication difficulties with surrogates who face complex informational and emotional barriers when making decisions for critically ill patients in the ICU. However, research on effective nurse communication focusing on both curative and end-of-life (EOL) care is lacking in the literature. DESIGN A single-centre two-group pretest-posttest quasi-experiment. METHOD The total sample included 41 surrogates of adult ventilated patients. Twenty participants were allocated to the intervention group who received a daily 20-min telephone call with content based on the COMFORT communication model. Twenty-one participants comprised the control group who received usual care. Participants completed a questionnaire before and after the study measuring satisfaction, anxiety and depression, decisional conflict, and quality of communication. The Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist was followed for nonrandomised controlled trials. RESULT The intervention was feasible, with 19 of 20 surrogates completing the follow-up surveys, and 48 telephone conversations completed (48% of the planned phone calls). Surrogates' satisfaction was higher in the intervention group than in the control group after adjusting for the selected covariates (25.43 and 24.15, respectively; p = .512). Preliminary efficacy outcomes favouring the intervention included quality of communication with healthcare providers, but not surrogates' perceived depression/anxiety and decisional conflicts. CONCLUSION Implementation of the intervention is feasible, acceptable, and favourable among surrogates to improve quality of communication with healthcare providers in the ICU. Further research is needed to determine whether the intervention could be implemented by nurses to improve surrogates' outcomes in other ICUs.
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Affiliation(s)
- Chiahui Chen
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Suzanne S Sullivan
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Rebecca A Lorenz
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Elaine Wittenberg
- Department of Communication Studies, California State University Los Angeles, Los Angeles, California, USA
| | - Chin-Shang Li
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Yu-Ping Chang
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
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Zhan Y, Yu J, Chen Y, Liu Y, Wang Y, Wan Y, Li S. Family caregivers' experiences and needs of transitional care during the transfer from intensive care unit to a general ward: A qualitative study. J Nurs Manag 2021; 30:592-599. [PMID: 34799985 DOI: 10.1111/jonm.13518] [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: 08/19/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/28/2022]
Abstract
AIM To explore the family caregivers' experiences and needs of transitional care during the transfer from an intensive care unit to a general ward in China. BACKGROUND The transfer of patients from the intensive care unit to the ward is a vulnerable time for patients and caregivers, exposing the risk of readmission and death. However, there are few qualitative studies on the family caregivers' views of transitional care for their loved ones in China. METHODS With a qualitative research design, 15 interviews were conducted with 15 family caregivers of hospitalized patients transferred from the neurosurgery ICU to the general ward. Colaizzi's (1978) method of data analysis was performed using the NVivo 11.0 software. RESULTS Based on data analysis, four themes were obtained: perception of transfer decision, the experience of transitional care, the obstacles to maintaining care efficiency and demand for transitional care. CONCLUSION In order to enhance the continuity of care and improve patient safety during the transfer from an ICU to a general ward in China, priorities should be given to the implementation of effective strategies and methods, including providing psychological and emotional support, encouraging active participation of caregivers, and various communication and collaboration procedures. IMPLICATIONS FOR NURSING MANAGEMENT The findings from this study can be used as a guide to better preparation and awareness among health care professionals to achieve the much-needed demands of family caregivers, as well as the increased quality of transitional care.
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Affiliation(s)
- Yuxin Zhan
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaohua Yu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Chen
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufang Liu
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingyue Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yali Wan
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suyun Li
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs 2021; 20:158. [PMID: 34479560 PMCID: PMC8414690 DOI: 10.1186/s12912-021-00684-2] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
Providing healthcare services that respect and meet patients' and caregivers' needs are essential in promoting positive care outcomes and perceptions of quality of care, thereby fulfilling a significant aspect of patient-centered care requirement. Effective communication between patients and healthcare providers is crucial for the provision of patient care and recovery. Hence, patient-centered communication is fundamental to ensuring optimal health outcomes, reflecting long-held nursing values that care must be individualized and responsive to patient health concerns, beliefs, and contextual variables. Achieving patient-centered care and communication in nurse-patient clinical interactions is complex as there are always institutional, communication, environmental, and personal/behavioural related barriers. To promote patient-centered care, healthcare professionals must identify these barriers and facitators of both patient-centered care and communication, given their interconnections in clinical interactions. A person-centered care and communication continuum (PC4 Model) is thus proposed to orient healthcare professionals to care practices, discourse contexts, and communication contents and forms that can enhance or impede the acheivement of patient-centered care in clinical practice.
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Affiliation(s)
- Abukari Kwame
- College of Graduate and Postdoctoral Studies, University of Saskatchewan, Saskatoon, Canada.
| | - Pammla M Petrucka
- College of Nursing, University of Saskatchewan, Regina Campus, Regina, Canada
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BAYKAL D, ÇAVUŞOĞLU A, ÖZTÜRK ERDEN S. Hasta Ailesinin, Nöroloji Yoğun Bakım Hemşireleriyle İletişiminin Araştırılması. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.38079/igusabder.870481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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