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Liyew TM, Mersha AT, Admassie BM, Arefayne NR. Family Satisfaction with Care Provided in Intensive Care Unit; a Multi-Center, Cross-Sectional Study. Patient Relat Outcome Meas 2024; 15:105-119. [PMID: 38680729 PMCID: PMC11048314 DOI: 10.2147/prom.s453246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Background Healthcare provided in medical facilities should prioritize the needs of families, as it enhances the quality of care for the patients. Family satisfaction gauges how effectively healthcare professionals address the perceived needs and expectations of family members. Numerous factors, including information dissemination, communication, family dynamics, patient characteristics, hospital facilities, and the caregiving process, serve as predictors of family satisfaction. Thus, this study seeks to evaluate the satisfaction of families with the care received by patients admitted to the intensive care unit. Methods A hospital-based cross-sectional study involving 400 participants was conducted across multiple centers from March to June 2023. Multicollinearity was assessed by examining variance inflation factors (VIF), while the goodness-of-fit was evaluated using the Hosmer and Lemeshow test. Both bivariable and multivariable logistic regression analyses were utilized to identify factors correlated with family satisfaction. Variables with a p-value below 0.2 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals were computed to indicate the strength of association. In the multivariable analysis, variables with a p-value less than 0.05 were deemed statistically significant. Results The overall family satisfaction with the care provided in the intensive care unit was 58.6%, with a 95% confidence interval ranging from 55.882% to 61.241%. Families expressed higher satisfaction levels with patient care (64.8%) and professional care (67.4%). However, they reported lower satisfaction levels regarding care provided for families (52.2%), the ICU environment (56.8%), and involvement of families in decision-making (55.8%). Lack of formal education (AOR: 1.949, 95% CI: 1.005, 4.169), completion of primary education (AOR: 2.581, 95% CI: 1.327, 5.021), and completion of grades 9-12 (AOR: 2.644, 95% CI: 1.411, 4.952) were found to be significantly associated with overall family satisfaction. Conclusion and recommendation The overall level of satisfaction is satisfactory. To enhance service quality and family satisfaction, healthcare providers should prioritize effective and regular communication with family members. Keeping them well informed about the patient's condition and treatment plan is essential.
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Affiliation(s)
- Temesgen Misganaw Liyew
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
| | - Abraham Tarekegn Mersha
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
| | - Belete Muluadam Admassie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
| | - Nurhusen Riskey Arefayne
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
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Tenge T, Schallenburger M, Batzler YN, Roth S, M Pembele R, Stroda A, Böhm L, Bernhard M, Jung C, Meier S, Kindgen-Milles D, Kienbaum P, Schwartz J, Neukirchen M. Perceptions on Specialist Palliative Care Involvement During and After Cardiopulmonary Resuscitation: A Qualitative Study. Crit Care Explor 2024; 6:e1077. [PMID: 38605722 PMCID: PMC11008654 DOI: 10.1097/cce.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
IMPORTANCE Cardiopulmonary resuscitation (CPR) is an exceptional physical situation and may lead to significant psychological, spiritual, and social distress in patients and their next of kin. Furthermore, clinicians might experience distress related to a CPR event. Specialist palliative care (sPC) integration could address these aspects but is not part of routine care. OBJECTIVES This study aimed to explore perspectives on sPC integration during and after CPR. A needs assessment for sPC, possible triggers indicating need, and implementation strategies were addressed. DESIGN SETTING AND PARTICIPANTS A multiprofessional qualitative semistructured focus group study was conducted in a German urban academic teaching hospital. Participants were clinicians (nursing staff, residents, and consultants) working in the emergency department and ICUs (internal medicine and surgical). ANALYSIS The focus groups were recorded and subsequently transcribed. Data material was analyzed using the content-structuring content analysis according to Kuckartz. RESULTS Seven focus groups with 18 participants in total were conducted online from July to November 2022. Six main categories (two to five subcategories) were identified: understanding (of palliative care and death), general CPR conditions (e.g., team, debriefing, and strains), prognosis (e.g., preexisting situation, use of extracorporeal support), next of kin (e.g., communication, presence during CPR), treatment plan (patient will and decision-making), and implementation of sPC (e.g., timing, trigger factors). CONCLUSIONS Perceptions about the need for sPC to support during and after CPR depend on roles, areas of practice, and individual understanding of sPC. Although some participants perceive CPR itself as a trigger for sPC, others define, for example, pre-CPR-existing multimorbidity or complex family dynamics as possible triggers. Suggestions for implementation are multifaceted, especially communication by sPC is emphasized. Specific challenges of extracorporeal CPR need to be explored further. Overall, the focus groups show that the topic is considered relevant, and studies on outcomes are warranted.
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Affiliation(s)
- Theresa Tenge
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Manuela Schallenburger
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Yann-Nicolas Batzler
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Sebastian Roth
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - René M Pembele
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Alexandra Stroda
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Lennert Böhm
- Emergency Department, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Bernhard
- Emergency Department, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stefan Meier
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Peter Kienbaum
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Jacqueline Schwartz
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Martin Neukirchen
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
- Interdisciplinary Center for Palliative Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Walter JK, Feudtner C, Cetin A, DeWitt AG, Zhou M, Montoya-Williams D, Olsen R, Griffis H, Williams C, Costarino A. Parental communication satisfaction with the clinical team in the paediatric cardiac ICU. Cardiol Young 2024; 34:282-290. [PMID: 37357911 PMCID: PMC10749983 DOI: 10.1017/s1047951123001555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Understanding parents' communication preferences and how parental and child characteristics impact satisfaction with communication is vital to mitigate communication challenges in the cardiac ICU. METHODS This cross-sectional survey was conducted from January 2019 to March 2020 in a paediatric cardiac ICU with parents of patients admitted for at least two weeks. Family satisfaction with communication with the medical team was measured using the Communication Assessment Tool for Team settings. Clinical characteristics were collected via Epic, Pediatric Cardiac Critical Care Consortium local entry and Society for Thoracic Surgeons Congenital Heart Surgery Databases. Associations between communication score and parental mood, stress, perceptions of clinical care, and demographic characteristics along with patient demographic and clinical characteristics were examined. Multivariable ordinal models were conducted with characteristics significant in bivariate analysis. RESULTS In total, 93 parents of 84 patients (86% of approached) completed surveys. Parents were 63% female and 70% White. Seventy per cent of patients were <6 months old at admission, 25% had an extracardiac abnormality, and 80% had a cardiac surgery this admission. Parents of children with higher pre-surgical risk of mortality scores (OR 2.875; 95%CI 1.076-7.678), presence of surgical complications (72 [63.0, 75.0] vs. 64 [95%CI 54.6, 73] (p = 0.0247)), and greater satisfaction with care in the ICU (r = 0.93922; p < 0.0001) had significantly higher communication scores. CONCLUSION These findings can prepare providers for scenarios with higher risk for communication challenges and demonstrate the need for further investigation into interventions that reduce parental anxiety and improve communication for patients with unexpected clinical trajectories.
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Affiliation(s)
- Jennifer K Walter
- Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arzu Cetin
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aaron G DeWitt
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle Zhou
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Montoya-Williams
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rob Olsen
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine Williams
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew Costarino
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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4
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Fortunatti CP, Silva NR, Silva YP, Canales DM, Veloso GG, Acuña JE, Castellon AD. Association between psychosocial factors and satisfaction with communication in family members of intensive care unit patients during COVID-19 pandemic: An exploratory cross-sectional study. Intensive Crit Care Nurs 2023; 76:103386. [PMID: 36706497 PMCID: PMC9826993 DOI: 10.1016/j.iccn.2023.103386] [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: 11/17/2022] [Revised: 12/22/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the relationship between satisfaction with communication and perceived stress, depressive symptoms and perceived social support among family members of critically ill. RESEARCH METHODOLOGY/DESIGN Exploratory, cross-sectional study was conducted. SETTING Private teaching hospital in Santiago, Chile. MAIN OUTCOMES MEASURES Family members of critically ill patients with 3-7 days of stay and respiratory support were approached. Questionnaires were used to assess satisfaction with communication (Family Satisfaction in the Intensive Care Unit-24), perceived stress (Perceived Stress Scale-10), depressive symptoms (Patient Health Questionnaire-9) and perceived social support (Medical Outcomes Study Social Support Survey). The relationship between satisfaction with communication and relevant variables was investigated using bivariate analyses and a beta regression. RESULTS The study included 42 family members, with 71.4% being female and 52.4% having prior critical care experience. There was a positive correlation between perceived stress and depressive symptoms (r = 0.32, p = 0.039). According to the beta regression, perceived social support (B; 95% confidence interval, 0.44 [1.05-2.29]) and the number of calls with unit staff (0.17 [1.06-1.32]) were positively associated with satisfaction with communication but negatively with college education (-1.86 [0.04-0.64]) and perceived stress (-0.07 [0.87-0.99]). CONCLUSION Psychosocial factors, such as higher educational level, perceived stress and perceived social support, can influence family members' evaluation of communication with staff. Current communication practices in acute care settings should be adapted to family members' psychosocial context to improve their satisfaction with the communication process. IMPLICATIONS FOR CLINICAL PRACTICE Critical care professionals must be aware of the influence of family member-related factors on the quality and effectiveness of the communication process. Psychosocial features of the family members are likely to impact their satisfaction with communication and should be assessed on admission and during their stay to assist clinicians to adjust and improve their communication practices.
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Affiliation(s)
- Cristobal Padilla Fortunatti
- Pontificia Universidad Católica de Chile, School of Nursing, Avda. Vicuña Mackenna 4860, Macul, 7820436 Santiago, Chile,Corresponding author
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Camões J, Tintim Lobato C, Carvalho D, Gomes E, Araújo R. Family Satisfaction in Intensive Care during the COVID-19 Pandemic Using the FS-ICU24 Questionnaire. ACTA MEDICA PORT 2022; 35:859-865. [PMID: 35699275 DOI: 10.20344/amp.17128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/26/2022] [Accepted: 04/18/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic caused an abrupt change in the pattern of communication involving patients, family members, and healthcare professionals. This study aimed to evaluate family member satisfaction with intensive care units (ICU) care and communication strategies during the COVID-19 pandemic. Secondary objectives included identification of areas requiring improvement, and assessment of the impact of both COVID-19 diagnosis and in-person visits on overall satisfaction. MATERIAL AND METHODS A prospective, observational single-center study was conducted among family members of ICU patients admitted between March and September 2020. During this period, ICU visiting policies suffered changes, ranging from full restrictions to eased limitations, which impacted ICU communication procedures and patient contact with family members. Three months after ICU discharge, the designated family members of patients were contacted and invited to fill in a questionnaire that assessed family satisfaction using a Likert response scale. RESULTS There was a total of 168 family members contacted (response rate of 57.7%). Most participants were globally satisfied with the care provided by the ICU staff and, apart from communication between nurses and family members, all other questions scored a satisfaction rate above 80%. The study found a statistically significant association between satisfaction and the consistency of clinical information provided and the possibility of having visits (p = 0.046). The odds ratio of being satisfied with information consistency was found to be 0.22 times lower in family members that were able to visit the patient in the ICU during the COVID-19 pandemic [OR = 0.22 (95% CI: 0.054 - 0.896)] compared with families that were unable to presential visit their family member. No statistically significant differences were found in the satisfaction rates between COVID-19 and non-COVID-19 admissions. CONCLUSION This is one of the first studies to assess satisfaction among family members of ICU patients during COVID-19 restrictions and the first, as far as we know, performed in the Portuguese population. The overall satisfaction levels were similar to the estimates found in previous studies. A lower degree of satisfaction with information consistency was found in family members who had in-person visits, possibly related with heterogeneity of senior doctors delivering information. COVID-19 diagnosis was not associated with decreased satisfaction.
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Affiliation(s)
- João Camões
- Intensive Care Unit. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
| | | | - Daniela Carvalho
- Intensive Care Unit. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
| | - Ernestina Gomes
- Intensive Care Unit. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
| | - Rui Araújo
- Intensive Care Unit. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal
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6
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Barlet MH, Ubel PA, Weinfurt KP, Glass HC, Pollak KI, Brandon DH, Lemmon ME. Decisional Satisfaction, Regret, and Conflict Among Parents of Infants with Neurologic Conditions. J Pediatr 2022; 245:81-88.e3. [PMID: 35227757 PMCID: PMC9232962 DOI: 10.1016/j.jpeds.2022.02.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To characterize decisional satisfaction, regret, and conflict among parents of critically ill infants with neurologic conditions. STUDY DESIGN In this prospective cohort study, we enrolled parents of infants with neurologic conditions in the intensive care unit (ICU). Hospital discharge surveys included the validated Family Satisfaction with the ICU (FS-ICU) decision making subscale, Decision Regret Scale (DRS), and Decisional Conflict Scale (DCS). We defined high satisfaction with decision making as an FS-ICU score ≥75, high decisional regret/conflict as DRS/DCS score >25, and within-couple disagreement as a difference of at least 25 points between scores. RESULTS We enrolled 61 parents of 40 infants (n = 40 mothers, n = 21 fathers); 35 mothers and 15 fathers completed surveys. Most mothers reported high satisfaction with decision making (27 of 35; 77%) and low decision regret (28 of 35; 80%); 40% (14 of 35) reported high decisional conflict. Mothers and fathers reported higher decisional conflict in the domains of uncertainty and values clarity compared with the domain of effective decision making (Bonferroni-corrected P < .05). There were no differences in decision outcomes between paired mothers and fathers; however, within any given couple, there were numerous instances of disagreement (7 of 15 for decision regret and 5 of 15 for decisional conflict). CONCLUSIONS Many parents experience decisional conflict even if they ultimately have high satisfaction and low regret, underscoring the need for decision aids targeting uncertainty and values clarity. Couples frequently experience different levels of decisional regret and conflict.
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Affiliation(s)
| | - Peter A. Ubel
- Duke University School of Medicine, Durham, NC, USA,Fuqua School of Business, Duke University, Durham, NC, USA,Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Kevin P. Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hannah C. Glass
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn I. Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Debra H. Brandon
- Duke University School of Nursing, Durham, NC, USA,Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Monica E. Lemmon
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA,Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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7
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Garg SK. Patients\' Family Satisfaction in Intensive Care Unit: A Leap Forward. Indian J Crit Care Med 2022; 26:161-163. [PMID: 35712749 PMCID: PMC8857726 DOI: 10.5005/jp-journals-10071-24120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Garg SK. Patients’ Family Satisfaction in Intensive Care Unit: A Leap Forward. Indian J Crit Care Med 2022;26(2):161–163.
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Affiliation(s)
- Sunil Kumar Garg
- Sunil Kumar Garg, Department of Critical Care, NMC Healthcare, Dubai, United Arab Emirates, Phone: +91-11-22334455, e-mail:
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8
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Weber U, Zhang Q, Ou D, Garritano J, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Vranceanu AM, Rosand J, Hwang DY. Predictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making. Neurocrit Care 2021; 35:714-722. [PMID: 33821402 PMCID: PMC8021441 DOI: 10.1007/s12028-021-01211-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a critical need to improve support for families making difficult shared decisions about patient care with clinicians in the neuroscience ICU (neuro-ICU). The aim of this study is to identify patient- and family-related factors associated with dissatisfaction with shared decision-making support among families of neuro-critically ill patients. METHODS We conducted a retrospective observational cohort study using survey data that had been collected from a consecutive sample of family members of patients in the neuro-ICU (one family member per patient) at two US academic centers. Satisfaction with shared decision-making support on ICU discharge had been measured among family members using one specific Likert scale item on the Family Satisfaction in the ICU 24 survey, a validated survey instrument for families of patients in the ICU. We dichotomized top-box responses for this particular item as an outcome variable and identified available patient- and family-related covariates associated with dissatisfaction (i.e., less than complete satisfaction) via univariate and multivariate analyses. RESULTS Among 355 surveys, 180 (49.5%) of the surveys indicated dissatisfaction with support during decision-making. In a multivariate model, no preexisting characteristics of families or patients ascertainable on ICU admission were predictive of dissatisfaction. However, among family factors determined during the ICU course, experiencing three or fewer formal family meetings (odds ratio 1.93 [confidence interval 1.13-3.31]; p = 0.01) was significantly predictive of dissatisfaction with decisional support in this cohort with an average patient length of stay of 8.6 days (SD 8.4). There was also a trend toward a family's decision to keep a patient as full code, without treatment limitations, being predictive of dissatisfaction (odds ratio 1.80 [confidence interval 0.93-3.51]; p = 0.08). CONCLUSIONS Family dissatisfaction with neuro-ICU shared decision-making support is not necessarily predicted by any preexisting family or patient variables but appears to correlate with participating in fewer formal family meetings during ICU admission. Future studies to improve family satisfaction with neurocritical care decision-making support should have broad inclusion criteria for participants and should consider promoting frequency of family meetings as a core strategy.
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Affiliation(s)
- Urs Weber
- Yale School of Medicine, Yale University, New Haven, CT, USA.,Yale New Haven Hospital, New Haven, CT, USA
| | - Qiang Zhang
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Derek Ou
- Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Long Island, NY, USA
| | - James Garritano
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | | | - Andrea K Knies
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Belinda Nhundu
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Cynthia Bautista
- School of Nursing and Health Studies, Fairfield University, Fairfield, CT, USA
| | - Kevin B Huang
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Harvard Medical School, Harvard University, Boston, MA, USA.,Division of Neurocritical Care and the Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA.,Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Harvard Medical School, Harvard University, Boston, MA, USA.,Division of Neurocritical Care and the Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - David Y Hwang
- Yale New Haven Hospital, New Haven, CT, USA. .,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA. .,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
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9
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Haave RO, Bakke HH, Schröder A. Family satisfaction in the intensive care unit, a cross-sectional study from Norway. BMC Emerg Med 2021; 21:20. [PMID: 33588760 PMCID: PMC7885442 DOI: 10.1186/s12873-021-00412-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/31/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Becoming critically ill represents not just a great upheaval for the patient in question, but also for the patient's closest family. In recent years, there has been a change in how the quality of the public health service is measured. There is currently a focus on how patients and their families perceive the quality of treatment and care. It can be challenging for patients to evaluate their stay in an intensive care unit (ICU) due to illness and treatment. Earlier studies show that the perceptions of the family and the patient may concur. It is important, therefore, to ascertain the family's level of satisfaction with the ICU stay. The aim of the study was to describe how the family evaluate their satisfaction with the ICU stay. A further aim was to identify which demographic variables were associated with differences in family satisfaction. METHOD The study had a cross-sectional design. A sample of 57 family members in two ICUs in Norway completed the questionnaire: Family satisfaction in the intensive care unit 24 (FS-ICU 24). Statistical analysis was conducted using the Mann-Whitney U test (U), Kruskal Wallis, Spearman rho and a performance-importance plot. RESULTS The results showed that families were very satisfied with a considerable portion of the ICU stay. Families were less satisfied with the information they received and the decision-making processes than with the nursing and care performed during the ICU stay. The results revealed that two demographic variables - relation to the patient and patient survival - significantly affected family satisfaction. CONCLUSION Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The results showed that some of the family demographic variables were significant for family satisfaction. The findings are clinically relevant since the results can strengthen intensive care nurses' knowledge when meeting the family of the intensive care patient.
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Affiliation(s)
- Randi Olsson Haave
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway.
| | | | - Agneta Schröder
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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10
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Naef R, von Felten S, Ernst J. Factors influencing post-ICU psychological distress in family members of critically ill patients: a linear mixed-effects model. Biopsychosoc Med 2021; 15:4. [PMID: 33588895 PMCID: PMC7885222 DOI: 10.1186/s13030-021-00206-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients. METHODS We conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first 3 months after their close other's ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures. RESULTS A total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression, and patient death was associated with higher levels of depression and posttraumatic stress. CONCLUSIONS Our results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Stefanie von Felten
- Department of Biostatistics, Institute of Epidemiology, Biostatistics, and Prevention, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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11
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Cook M, Zonies D, Brasel K. Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient. CURRENT TRAUMA REPORTS 2020; 6:183-193. [PMID: 33145148 PMCID: PMC7595000 DOI: 10.1007/s40719-020-00201-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
Purpose of Review Communication skills in the ICU are an essential part of the care of trauma patients. The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU. Recent Findings The need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication. Summary We have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees.
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Affiliation(s)
- Mackenzie Cook
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230 USA
| | - David Zonies
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230 USA
| | - Karen Brasel
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230 USA
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12
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A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention. Pediatr Crit Care Med 2020; 21:e617-e627. [PMID: 32639470 DOI: 10.1097/pcc.0000000000002378] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure. DESIGN Patient-level, randomized trial. SETTING Two university-based, tertiary-care children's hospital PICUs. PARTICIPANTS Parents of patients requiring more than 24 hours in the PICU. INTERVENTIONS PICU Supports included adding a trained navigator to the patient's healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers. MEASUREMENTS AND MAIN RESULTS The primary outcome was percentage of "excellent" responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3-5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3-5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; SE, 4.53; 95% CI, -5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as "extremely" or "somewhat" helpful. CONCLUSIONS Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.
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13
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Weber U, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Hamza M, White J, Coppola A, Akgün KM, Greer DM, Marcolini EG, Gilmore EJ, Petersen NH, Timario N, Poskus K, Sheth KN, Hwang DY. Dedicated Afternoon Rounds for ICU Patients' Families and Family Satisfaction With Care. Crit Care Med 2019; 46:602-611. [PMID: 29300237 DOI: 10.1097/ccm.0000000000002963] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It was hypothesized that adding dedicated afternoon rounds for patients' families to supplement standard family support would improve overall family satisfaction with care in a neuroscience ICU. DESIGN Pre- and postimplementation (pre-I and post-I) design. SETTING Single academic neuroscience ICU. PATIENTS Patients in the neuroscience ICU admitted for longer than 72 hours or made comfort measures only at any point during neuroscience ICU admission. INTERVENTION The on-service attending intensivist and a neuroscience ICU nursing leader made bedside visits to families to address concerns during regularly scheduled, advertised times two afternoons each week. MEASUREMENTS AND MAIN RESULTS One family member per patient during the pre-I and post-I periods was recruited to complete the Family Satisfaction in the ICU 24 instrument. Post-I respondents indicated whether they had participated in the afternoon rounds. For primary outcome, the mean pre-I and post-I composite Family Satisfaction in the ICU 24 scores (on a 100-point scale) were compared. A total of 146 pre-I (March 2013 to October 2014; capture rate, 51.6%) and 141 post-I surveys (October 2014 to December 2015; 47.2%) were collected. There was no difference in mean Family Satisfaction in the ICU 24 score between groups (pre-I, 89.2 ± 11.2; post-I, 87.4 ± 14.2; p = 0.6). In a secondary analysis, there was also no difference in mean Family Satisfaction in the ICU 24 score between the pre-I respondents and the 39.0% of post-I respondents who participated in family rounds. The mean Family Satisfaction in the ICU 24 score of the post-I respondents who reported no participation trended lower than the mean pre-I score, with fewer respondents in this group reporting complete satisfaction with emotional support (75% vs. 54%; p = 0.002), coordination of care (82% vs. 68%; p = 0.03), and frequency of communication by physicians (60% vs. 43%; p = 0.03). CONCLUSIONS Dedicated afternoon rounds for families twice a week may not necessarily improve an ICU's overall family satisfaction. Increased dissatisfaction among families who do not or cannot participate is possible.
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Affiliation(s)
- Urs Weber
- Yale School of Medicine, New Haven, CT
| | | | | | | | | | | | | | | | | | | | - Kathleen M Akgün
- Department of Internal Medicine, Pulmonary, Critical Care and Sleep Medicine Section, VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, CT
| | - David M Greer
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Evie G Marcolini
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Emily J Gilmore
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | - Nils H Petersen
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | | | | | - Kevin N Sheth
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | - David Y Hwang
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
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14
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Ferrando P, Gould DW, Walmsley E, Richards-Belle A, Canter R, Saunders S, Harrison DA, Harvey S, Heyland DK, Hinton L, McColl E, Richardson A, Richardson M, Wright SE, Rowan KM. Family satisfaction with critical care in the UK: a multicentre cohort study. BMJ Open 2019; 9:e028956. [PMID: 31434771 PMCID: PMC6707657 DOI: 10.1136/bmjopen-2019-028956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To assess family satisfaction with intensive care units (ICUs) in the UK using the Family Satisfaction in the Intensive Care Unit 24-item (FS-ICU-24) questionnaire, and to investigate how characteristics of patients and their family members impact on family satisfaction. DESIGN Prospective cohort study nested within a national clinical audit database. SETTING Stratified, random sample of 20 adult general ICUs participating in the Intensive Care National Audit & Research Centre Case Mix Programme. PARTICIPANTS Family members of patients staying at least 24 hours in ICU were recruited between May 2013 and June 2014. INTERVENTIONS Consenting family members were sent a postal questionnaire 3 weeks after the patient died or was discharged from ICU. Up to four family members were recruited per patient. MAIN OUTCOME MEASURES Family satisfaction was measured using the FS-ICU-24 questionnaire. MAIN RESULTS A total of 12 346 family members of 6380 patients were recruited and 7173 (58%) family members of 4615 patients returned a completed questionnaire. Overall and domain-specific family satisfaction scores were high (mean overall family satisfaction 80, satisfaction with care 83, satisfaction with information 76 and satisfaction with decision-making 73 out of 100) but varied significantly across adult general ICUs studied and by whether the patient survived ICU. For family members of ICU survivors, characteristics of both the family member (age, ethnicity, relationship to patient (next-of-kin and/or lived with patient) and visit frequency) and the patient (acute severity of illness and receipt of invasive mechanical ventilation) were significant determinants of family satisfaction, whereas, for family members of ICU non-survivors, only patient characteristics (age, acute severity of illness and duration of stay) were significant. CONCLUSIONS Overall family satisfaction in UK adult general ICUs was high but varied significantly. Adjustment for differences in family member/patient characteristics is important to avoid falsely identifying ICUs as statistical outliers. TRIAL REGISTRATION NUMBER ISRCTN47363549.
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Affiliation(s)
- Paloma Ferrando
- Intensive Care National Audit and Research Centre, London, UK
| | - Doug W Gould
- Intensive Care National Audit and Research Centre, London, UK
| | - Emma Walmsley
- Intensive Care National Audit and Research Centre, London, UK
| | | | - Ruth Canter
- Intensive Care National Audit and Research Centre, London, UK
| | - Steven Saunders
- Intensive Care National Audit and Research Centre, London, UK
| | | | - Sheila Harvey
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada
| | - Lisa Hinton
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elaine McColl
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette Richardson
- Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Stephen E Wright
- Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, UK
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15
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Scott P, Thomson P, Shepherd A. Families of patients in ICU: A Scoping review of their needs and satisfaction with care. Nurs Open 2019; 6:698-712. [PMID: 31367391 PMCID: PMC6650754 DOI: 10.1002/nop2.287] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 11/09/2022] Open
Abstract
AIM To describe published literature on the needs and experiences of family members of adults admitted to intensive care and interventions to improve family satisfaction and psychological well-being and health. DESIGN Scoping review. METHODS Several selective databases were searched. English-language articles were retrieved, and data extracted on study design, sample size, sample characteristics and outcomes measured. RESULTS From 469 references, 43 studies were identified for inclusion. Four key themes were identified: (a) Different perspectives on meeting family needs; (b) Family satisfaction with care in intensive care; (c) Factors having an impact on family health and well-being and their capacity to cope; and (d) Psychosocial interventions. Unmet informational and assurance needs have an impact on family satisfaction and mental health. Structured written and oral information shows some effect in improving satisfaction and reducing psychological burden. Future research might include family in the design of interventions, provide details of the implementation process and have clearly identified outcomes.
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Affiliation(s)
- Pamela Scott
- Intensive Care UnitForth Valley Royal HospitalLarbertUK
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16
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Sviri S, Geva D, vanHeerden PV, Romain M, Rawhi H, Abutbul A, Orenbuch-Harroch E, Bentur N. Implementation of a structured communication tool improves family satisfaction and expectations in the intensive care unit. J Crit Care 2019; 51:6-12. [DOI: 10.1016/j.jcrc.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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17
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Midega TD, Oliveira HSBD, Fumis RRL. Satisfaction of family members of critically ill patients admitted to a public hospital intensive care unit and correlated factors. Rev Bras Ter Intensiva 2019; 31:147-155. [PMID: 31141080 PMCID: PMC6649209 DOI: 10.5935/0103-507x.20190024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/02/2019] [Indexed: 11/24/2022] Open
Abstract
Objective To analyze the satisfaction, medical situation understanding and symptoms of
anxiety and depression in family members of patients admitted to the
intensive care unit. Methods The family members of patients who were hospitalized for ≥ 72 hours
were invited to participate in the study, which was performed in a public
hospital. Questionnaires were answered to assess the understanding of the
diagnosis, treatment and prognosis, and the support received in the
intensive care unit. The family needs were also evaluated using a modified
version of the Critical Care Family Needs Inventory (CCFNI). The Hospital
Anxiety and Depression Scale (HADS) was used to assess the symptoms of
anxiety and depression. Results A total of 35 family members were interviewed within the patients' first week
of stay in the intensive care unit. Most patients (57.1%) were male, aged 54
± 19 years. Sepsis was the main reason for admission to the intensive
care unit (40%); the median of the Simplified Acute Physiology Score (SAPS)
3 was 68 (48 - 77), and 51.4% of the patients died in the intensive care
unit. The majority of the family members were female (74.3%) and were sons
or daughters of patients (54.3%), with a mean age of 43.2 ± 14 years.
Overall, 77.1% of the family members were satisfied with the intensive care
unit. A total of 37.1% of the family members did not understand the
prognosis. Receiving clear and complete information in the intensive care
unit and the doctor being accessible were factors that were significantly
correlated with the overall family satisfaction. The prevalence of symptoms
of anxiety (60%) and depression (54.3%) in the family members was high. Conclusion The emotional distress of family members is high during a patient's
hospitalization in the intensive care unit, although satisfaction is also
high. Clear and complete information provided by the intensivist and the
support received in the intensive care unit are significantly correlated
with the satisfaction of family members in a public hospital.
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Affiliation(s)
- Thais Dias Midega
- Unidade de Terapia Intensiva, Hospital Geral do Grajaú - São Paulo (SP), Brasil
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18
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Thimmapur RM, Raj P, Raju B, Kanmani TR, Reddy NK. Caregivers satisfaction with intensive care unit services in tertiary care hospital. Int J Crit Illn Inj Sci 2019; 8:184-187. [PMID: 30662863 PMCID: PMC6311964 DOI: 10.4103/ijciis.ijciis_25_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Caregivers play a vital role in intensive care unit (ICU) because critically ill patients cannot make their own decisions due to their illness. Measuring family satisfaction on quality of ICU care is essential. Hence, the current paper aimed to measure the family caregiver satisfaction in ICU care in tertiary care hospital. Methods The study adopted descriptive research design conducted from July 2016 to January 2017 at ICU in Emergency and Trauma Care center. A total number of 60 consented caregivers were recruited. An Internationally validated Family satisfaction survey questionnaire (FS) was used. Continuous variables of the data were described by mean standard deviation and categorical variables by frequency (%). Normality of the continuous variables was checked by Shapiro-Wilk test. Kruskal-Wallis test was used to compare the average FS score between the groups. Results Results showed that caregiver age was ranged between 25 and 66 years with mean age 40 (±19). Among the caregivers, 75% were male and 25% were female of which 75% were married and remaining were unmarried. Around half of the caregivers (48.3) were educated up to primary or secondary and 26.7% had higher secondary education level. About 46.7% involved in manual laborers and 36.7% were working in the private sector. Family members had taken primary caregiving role without prior experience (81.7%) at ICU. Almost 95% of the caregivers were highly satisfied with ICU care and only 5% were not satisfied. Conclusion Majority of caregivers are satisfied with ICU care. However, adequate measures need to be taken to ensure the complete satisfaction among caregivers at ICU.
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Affiliation(s)
| | - Prabhu Raj
- Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India
| | - Birudu Raju
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - T R Kanmani
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - N Krishna Reddy
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
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19
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McAdam JL, Puntillo K. Pilot Study Assessing the Impact of Bereavement Support on Families of Deceased Intensive Care Unit Patients. Am J Crit Care 2018; 27:372-380. [PMID: 30173170 DOI: 10.4037/ajcc2018575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Family members of patients who die in an intensive care unit (ICU) may experience negative outcomes. However, few studies have assessed the effectiveness of bereavement care for families. OBJECTIVE To evaluate the effectiveness of bereavement follow-up on family members' anxiety, depression, posttraumatic stress, prolonged grief, and satisfaction with care. METHODS A cross-sectional, prospective pilot study of 40 family members of patients who died in 2 tertiary care ICUs. Those in the medical-surgical ICU received bereavement follow-up (bereavement group); those in the cardiac ICU received standard care (nonbereavement group). Both groups completed surveys 13 months after the death. Surveys included the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Family Satisfaction With Care in the Intensive Care Unit, Prolonged Grief Disorder, and a bereavement survey. RESULTS Of 30 family members in the bereavement group and 10 in the nonbereavement group, most were female and spouses, with a mean (SD) age of 60.1 (13.3) years. Significantly more participants in the nonbereavement group than in the bereavement group had prolonged grief. Posttraumatic stress, anxiety, depression, and satisfaction with care were not significantly different in the 2 groups. However, overall posttraumatic stress scores were higher in the nonbereavement group than the bereavement group, indicating a higher risk of posttraumatic stress disorder. CONCLUSIONS Bereavement follow-up after an ICU death reduced family members' prolonged grief and may also reduce their risk of posttraumatic stress disorder. This type of support did not have a measurable effect on depression or satisfaction with ICU care.
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Affiliation(s)
- Jennifer L. McAdam
- Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, San Francisco, California
| | - Kathleen Puntillo
- Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, San Francisco, California
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20
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Turnbull AE, Sahetya SK, Colantuoni E, Kweku J, Nikooie R, Curtis JR. Inter-Rater Agreement of Intensivists Evaluating the Goal Concordance of Preference-Sensitive ICU Interventions. J Pain Symptom Manage 2018; 56:406-413.e3. [PMID: 29902555 PMCID: PMC6456035 DOI: 10.1016/j.jpainsymman.2018.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Goal-concordant care has been identified as an important outcome of advance care planning and shared decision-making initiatives. However, validated methods for measuring goal concordance are needed. OBJECTIVES To estimate the inter-rater reliability of senior critical care fellows rating the goal concordance of preference-sensitive interventions performed in intensive care units (ICUs) while considering patient-specific circumstances as described in a previously proposed methodology. METHODS We identified ICU patients receiving preference-sensitive interventions in three adult ICUs at Johns Hopkins Hospital. A simulated cohort was created by randomly assigning each patient one of 10 sets of goals and preferences about limiting life support. Critical care fellows then independently reviewed patient charts and answered two questions: 1) Is this patient's goal achievable? and 2) Will performing this intervention help achieve the patient's goal? When the answer to both questions was yes, the intervention was rated as goal concordant. Inter-rater agreement was summarized by estimating intraclass correlation coefficient using mixed-effects models. RESULTS Six raters reviewed the charts of 201 patients. Interventions were rated as goal concordant 22%-92% of the time depending on the patient's goal-limitation combination. Percent agreement between pairs of raters ranged from 59% to 86%. The intraclass correlation coefficient for ratings of goal concordance was 0.50 (95% CI 0.31-0.69) and was robust to patient age, gender, ICU, severity of illness, and lengths of stay. CONCLUSION Inter-rater agreement between intensivists using a standardized methodology to evaluate the goal concordance of preference-sensitive ICU interventions was moderate. Further testing is needed before this methodology can be recommended as a clinical research outcome.
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Affiliation(s)
- Alison E Turnbull
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Sarina K Sahetya
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Josephine Kweku
- Department of Anesthesiology and Critical Care, Anne Arundel Medical Center, Annapolis, Maryland, USA
| | - Roozbeh Nikooie
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland, USA
| | - J Randall Curtis
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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21
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Law AC, Roche S, Reichheld A, Folcarelli P, Cocchi MN, Howell MD, Sands K, Stevens JP. Failures in the Respectful Care of Critically Ill Patients. Jt Comm J Qual Patient Saf 2018; 45:276-284. [PMID: 30170754 DOI: 10.1016/j.jcjq.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The emotional toll of critical illness on patients and their families can be profound and is emerging as an important target for value improvement. One source of emotional harm to patients and families may be care perceived as inadequately respectful. The prevalence and risk factors for types of emotional harms is under-studied. METHODS This prospective cohort study was conducted in nine ICUs at a tertiary care academic medical center in the United States. Prevalence of inadequate respect for (a) the patient and (b) the family, as well as prevalence of perceived lack of control over the care of their loved ones, was assessed by the Family Satisfaction with Care in the Intensive Care Unit instrument. The relationship between these outcomes with demographic and clinical covariates was assessed. Stratification by patient survivorship was performed in sensitivity analysis. RESULTS Of more than 1,500 respondents, 16.9% and 21.8% reported that the patient or the family member, respectively, received inadequate respect. No clinical characteristics of the patients were associated with inadequate respect for either the patient or the family member. By comparison, more than half of respondents reported a lack of control over their loved one's care; this finding was associated with multiple clinical factors. Prevalence and associated factors differed by patient survivorship status. CONCLUSION Care that is inadequately respectful to patients and families in the setting of critical illness is prevalent but does not appear to be associated with clinical characteristics. The incidence of such emotional harms is nuanced, difficult to predict, and deserves further investigation.
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Perspectives on strained intensive care unit capacity: A survey of critical care professionals. PLoS One 2018; 13:e0201524. [PMID: 30133479 PMCID: PMC6104911 DOI: 10.1371/journal.pone.0201524] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 06/18/2018] [Indexed: 01/09/2023] Open
Abstract
Background Strained intensive care unit (ICU) capacity represents a supply-demand mismatch in ICU care. Limited data have explored health care worker (HCW) perceptions of strain. Methods Cross-sectional survey of HCW across 16 Alberta ICUs. A web-based questionnaire captured data on demographics, strain definition, and sources, impact and strategies for management. Results 658 HCW responded (33%; 95%CI, 32–36%), of which 452 were nurses (69%), 128 allied health (19%), 45 physicians (7%) and 33 administrators (5%). Participants (agreed/strongly agreed: 94%) reported that strain was best defined as “a time-varying imbalance between the supply of available beds, staff and/or resources and the demand to provide high-quality care for patients who may become or who are critically ill”; while some recommended defining “high-quality care”, integrating “safety”, and families in the definition. Participants reported significant contributors to strain were: “inability to discharge ICU patients due to lack of available ward beds” (97%); “increases in the volume” (89%); and “acuity and complexity of patients requiring ICU support” (88%). Strain was perceived to “increase stress levels in health care providers” (98%); and “burnout in health care providers” (96%). The highest ranked strategies were: “have more consistent and better goals-of-care conversations with patients/families outside of ICU” (95%); and “increase non-acute care beds” (92%). Interpretation Strain is perceived as common. HCW believe precipitants represent a mix of patient-related and operational factors. Strain is thought to have negative implications for quality of care, HCW well-being and workplace environment. Most indicated strategies “outside” of ICU settings were priorities for managing strain.
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Abstract
BACKGROUND Examine the association of a daily palliative care needs checklist on outcomes for family members of patients discharged from the neurosciences intensive care unit (neuro-ICU). METHODS We conducted a prospective, longitudinal cohort study in a single, thirty-bed neuro-ICU in a regional comprehensive stroke and level 1 trauma center. One of two neuro-ICU services that admit patients to the same ICU on alternating days used a palliative care needs checklist during morning work rounds. Between March and October, 2015, surveys were mailed to family members of patients discharged from the neuro-ICU. RESULTS Nearly half of surveys (n = 91, 48.1%) were returned at a median of 4.7 months. At the time of survey completion, mean Modified rankin scale score (mRS) of neuro-ICU patients was 3.1 (SD 2). Overall ratings of quality of care were relatively high (82.2 on a 0-100 scale) with 32% of family members meeting screening criteria for depressive syndrome. The primary outcome measuring family satisfaction, consisting of eight items from the Family Satisfaction in the ICU questionnaire, did not differ significantly between families of patients from either ICU service nor did family ratings of depression (PHQ-8) and post-traumatic stress (PCL-17). CONCLUSIONS Among families of patients discharged from the neuro-ICU, the daily use of a palliative care needs checklist had no measurable effect on family satisfaction scores or long-term psychological outcomes. Further research is needed to identify optimal interventions to meet the palliative care needs specific to family members of patients treated in the neuro-ICU.
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Min J, Kim Y, Lee JK, Lee H, Lee J, Kim KS, Cho YJ, Jo YH, Ryu HG, Kim K, Lee SM, Lee YJ. Survey of family satisfaction with intensive care units: A prospective multicenter study. Medicine (Baltimore) 2018; 97:e11809. [PMID: 30095649 PMCID: PMC6133602 DOI: 10.1097/md.0000000000011809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022] Open
Abstract
Although family satisfaction is an important indicator for quality improvement of intensive care units (ICUs), few studies have translated family satisfaction data into quality improvement in Asia. A prospective multicenter study was conducted to evaluate family satisfaction regarding the care of patients and their family.The family satisfaction in the ICU (FS-ICU) questionnaire was administered from January 2015 to February 2016 at ICUs of 3 tertiary teaching hospitals in South Korea. Family members of adult patients, staying at an ICU for ≥48 hours, were included. Key factors affecting satisfaction were identified using quantitative and qualitative analyses.In total, 200 family members participated in this survey. The mean score for overall family satisfaction (FS-ICU/total) was 75.4 ± 17.7. The mean score for satisfaction with information/decision-making was greater than that for satisfaction with care (78.2 ± 18.2 vs 73.5 ± 19.4; P ≤ .001). Family members who agreed to not resuscitate and whose patient died at the ICU had lower FS-ICU/total scores. When compared with hospital A, hospital C was an independent predictor with an FS-ICU/total score of <75. Families reported the least satisfaction for the atmosphere of the ICU, including the waiting room atmosphere and management of agitation.We evaluated family satisfaction regarding ICUs for the first time in Asia using a validated tool. The decision to not resuscitate, ICU mortality, and ICU culture were associated with family satisfaction with critical care. Efforts should be targeted for improving factors that cause low family satisfaction when planning quality improvement interventions for ICUs in Asia.
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Affiliation(s)
- Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
| | - Youlim Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | | | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
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Kalocsai C, Amaral A, Piquette D, Walter G, Dev SP, Taylor P, Downar J, Gotlib Conn L. "It's better to have three brains working instead of one": a qualitative study of building therapeutic alliance with family members of critically ill patients. BMC Health Serv Res 2018; 18:533. [PMID: 29986722 PMCID: PMC6038351 DOI: 10.1186/s12913-018-3341-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Studies in the intensive care unit (ICU) suggest that better communication between families of critically ill patients and healthcare providers is needed; however, most randomized trials targeting interventions to improve communication have failed to achieve family-centered outcomes. We aim to offer a novel analysis of the complexities involved in building positive family-provider relationships in the ICU through the consideration of not only communication but other important aspects of family-provider interactions, including family integration, collaboration, and empowerment. Our goal is to explore family members’ perspectives on the enablers and challenges to establishing therapeutic alliance with ICU physicians and nurses. Methods We used the concept of therapeutic alliance as an organizational and analytic tool to conduct an interview-based qualitative study in a 20-bed adult medical-surgical ICU in an academic hospital in Toronto, Canada. Nineteen family members of critically ill patients who acted as substitute decision-makers and/or regularly interacted with ICU providers were interviewed. Participants were sampled purposefully to ensure maximum variation along predetermined criteria. A hybrid inductive-deductive approach to analysis was used. Results Participating family members highlighted the complementary roles and practices of ICU nurses and physicians in building therapeutic alliance. They reported how both provider groups had profession specific and shared contributions to foster family communication, integration, and collaboration, while physicians played a key role in family empowerment. Families’ lack of familiarity with ICU personnel and processes, physicians’ sporadic availability and use of medical jargon during rounds, however, reinforced long established power differences between lay families and expert physicians and challenged family integration. Family members also identified informal interactions as missed opportunities for relationship-building with physicians. While informal interactions with nurses at the bedside facilitated therapeutic alliance, inconsistent and ad-hoc interactions related to routine decision-making hindered family empowerment. Conclusions Multiple opportunities exist to improve family-provider relationships in the ICU. The four dimensions of therapeutic alliance prove analytically useful to highlight those aspects that work well and need improvement, such as in the areas of family integration and empowerment. Electronic supplementary material The online version of this article (10.1186/s12913-018-3341-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Csilla Kalocsai
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. .,Patient/Client and Family Education, Centre for Mental Health and Addiction, 33 Russell Street, Toronto, Ontario, M5S 3M1, Canada.
| | - Andre Amaral
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dominique Piquette
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Grace Walter
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Shelly P Dev
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Taylor
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - James Downar
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Palliative Medicine, University of Toronto, Toronto, Canada
| | - Lesley Gotlib Conn
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
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Lamiani G, Ciconali M, Argentero P, Vegni E. Clinicians’ moral distress and family satisfaction in the intensive care unit. J Health Psychol 2018; 25:1894-1904. [DOI: 10.1177/1359105318781935] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explored the relationship between clinicians’ moral distress and family satisfaction with care in five intensive care units in Italy. A total of 122 clinicians (45 physicians and 77 nurses) and 59 family members completed the Italian Moral Distress Scale-Revised and the Family Satisfaction in the ICU questionnaire, respectively. Clinicians’ moral distress inversely correlated with family satisfaction related to the inclusion in the decision-making process. Specifically, physicians’ moral distress inversely correlated with satisfaction regarding the respect shown toward the patient. Nurses’ moral distress inversely correlated with satisfaction regarding breathlessness and agitation management, provision of emotional support, understanding of information, and inclusion in the decision-making process.
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Affiliation(s)
- Giulia Lamiani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Matteo Ciconali
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
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Neves JDL, Schwartz E, Guanilo MEE, Amestoy SC, Mendieta MDC, Lise F. AVALIAÇÃO DA SATISFAÇÃO DE FAMILIARES DE PACIENTES ATENDIDOS EM UNIDADES DE TERAPIA INTENSIVA: REVISÃO INTEGRATIVA. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0104-070720180001800016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
RESUMO Objetivo: analisar a produção científica relacionada às evidências acerca da satisfação de familiares de pacientes de UTI e os instrumentos utilizados para sua avaliação. Metodo: revisão integrativa na qual foram analisados artigos publicados entre 2005 e 2015, em inglês, português ou espanhol, nas bases de dados PUBMED/MEDLINE e LILACS e a biblioteca SciELO. Utilizou-se como estratégia de busca: personal satisfactional OR satisfaction AND family. Para coleta de dados dos artigos elaborou-se um instrumento com informações como: título, autores, ano de publicação e revista, objetivo do estudo, delineamento, participantes, local da pesquisa, temática principal e resultados. Resultados: atenderam aos critérios de inclusão 27 produções. Foram identificados quatro instrumentos utilizados para avaliar a satisfação de familiares de pacientes na UTI o Critical Care Family Satisfaction Survey, Family Satisfaction in the Intensive Care Unit, Critical Care Family Needs Inventory e o Quality of Dying and Death. Os estudos abordaram a satisfação dos familiares em relação às suas necessidades e tomadas de decisão, satisfação quanto a cuidados paliativos, evidenciou-se, ainda, estudos de adaptação transcultural e validação de instrumentos. Quanto ao nível de evidência, os estudos se concentram nos níveis II a VI. Conclusão: a análise da produção científica sobre a satisfação de familiares de pacientes de UTI permitiu evidenciar que o fator que mais contribui na promoção da satisfação da família foi a qualidade do atendimento.
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Long AC, Kross EK, Curtis JR. Family-centered outcomes during and after critical illness: current outcomes and opportunities for future investigation. Curr Opin Crit Care 2018; 22:613-620. [PMID: 27685849 DOI: 10.1097/mcc.0000000000000360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Family-centered outcomes during and after critical illness assess issues that are most important to family members. An understanding of family-centered outcomes is necessary to support the provision of family-centered care and to foster development of interventions to improve care and communication in the ICU. RECENT FINDINGS Current family-centered outcomes in critical care include satisfaction with care, including end-of-life care, symptoms of psychological distress, and health-related quality of life. Novel measures include assessments of decisional conflict, decision regret, therapeutic alliance, and caregiver burden, as well as positive adaptations and resilience. SUMMARY Critical illness places a significant burden on family members. A wide variety of family-centered outcomes are available to guide improvements in care and communication. Future research should focus on developing sensitive and responsive measures that capture key elements of the family member experience during and after critical illness.
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Affiliation(s)
- Ann C Long
- aDivision of Pulmonary and Critical Care Medicine, Harborview Medical Center bCambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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Wong P, Liamputtong P, Koch S, Rawson H. Barriers to families' regaining control in ICU: Disconnectedness. Nurs Crit Care 2017; 23:95-101. [PMID: 28849608 DOI: 10.1111/nicc.12310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The nature of interactions between health care professionals and families may have a significant impact on families' experience and outcomes of critical illness. The value of encouraging positive relationships with families is well documented; however, it is argued that the lack of theoretical frameworks to guide practice in this area may be a barrier to improving patient- and family-centred care. AIMS The study on which this paper is based aimed to understand families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit and to generate a substantive theory that represents families' interactions that can be used to guide critical care nursing practice when caring for patients' families in this context. DESIGN AND METHODS A grounded theory methodology was adopted for the study. Data were collected between 2009 and 2013 using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit (ICU) in Australia. FINDINGS A core category of regaining control has been generated from our study. This paper focuses on Disconnectedness, which leads to increased emotional vulnerability and is also a barrier to families' regaining control. Families feel disconnected when staff emotionally and physically disengage from them, when staff interact insensitively and in a manner that offers families limited hope. CONCLUSION Our findings offer an in-depth understanding of staff engagement with families and its impact on the families' ability to regain control. Although some themes have been previously identified in the literature in isolation, the interrelationships of the categories within a theoretical framework to represent family resilience in the context of an ICU situated in the Australian health care system are a novel finding. RELEVANCE TO CLINICAL PRACTICE The findings can be used to support patient- and family-centred care interventions in the ICU.
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Affiliation(s)
- Pauline Wong
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Pranee Liamputtong
- School of Science and Health, Western Sydney University, Campbelltown Campus, Penrith, Australia
| | - Susan Koch
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,University of Sydney Medical School, Hornsby Ku-ring-gai Hospital, Hornsby, Australia
| | - Helen Rawson
- School of Nursing & Midwifery, Faculty of Health, Deakin University, Geelong, Australia
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30
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Oczkowski SJW, Au S, des Ordons AR, Gill M, Potestio ML, Smith O, Sinuff T, Stelfox HT, Fox-Robichaud AE. A modified Delphi process to identify clinical and research priorities in patient and family centred critical care. J Crit Care 2017; 42:243-247. [PMID: 28800520 DOI: 10.1016/j.jcrc.2017.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/14/2017] [Accepted: 08/04/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify elements which enable patient and family centred care (PFCC) in the intensive care unit (ICU) and priorities for PFCC research. MATERIALS AND METHODS We engaged a panel of multidisciplinary stakeholders in a modified Delphi process. Items generated from a literature review and panelist suggestions were rated in 3 successive rounds on a scale from 1 to 7. Median score was used to rate each item's priority, with 5 or more indicating "essential priority," 4 or 5 "moderate priority" and 3 or less "low priority." Interquartile range (IQR) was used to measure consensus, with IQR of 1 indicating "high" consensus, 2 "moderate" consensus, and 3 or greater "low" consensus. RESULTS Six items were rated essential elements for facilitating PFCC with high consensus (flexible visiting hours, family participation in bedside care, trained family support person, interventions to facilitate continuity of care, staff education to support families, continuity of staff assignments). Three items were rated essential research topics: interventions to facilitate continuity of care following ICU discharge (moderate consensus), family participation in bedside care (low consensus), and decision aids for end of life decision-making (low consensus). CONCLUSIONS Stakeholders identified clear and distinct priorities for PFCC in clinical care and research, though there was greater consensus for clinical care.
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Affiliation(s)
- Simon J W Oczkowski
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada.
| | - Selena Au
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Amanda Roze des Ordons
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada; Division of Palliative Care, University of Calgary, Calgary, Canada
| | - Marlyn Gill
- PaCER (Patient and Community Engagement Research) Program, University of Calgary, Calgary, Canada
| | - Melissa L Potestio
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Orla Smith
- Critical Care Department, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, Canada.; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Sunnybrook Research Institute, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Alison E Fox-Robichaud
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada
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Cicekci F, Duran N, Ayhan B, Arican S, Ilban O, Kara I, Turkoglu M, Yildirim F, Hasirci I, Karaibrahimoglu A, Kara I. The communication between patient relatives and physicians in intensive care units. BMC Anesthesiol 2017; 17:97. [PMID: 28716040 PMCID: PMC5513098 DOI: 10.1186/s12871-017-0388-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients in intensive care units (ICUs) are often physically unable to communicate with their physicians. Thus, the sharing of information about the on-going treatment of the patients in ICUs is directly related to the communication attitudes governing a patient's relatives and the physician. This study aims to analyze the attitudes displayed by the relatives of patients and the physician with the purpose of determining the communication between the two parties. METHODS For data collection, two similar survey forms were created in context of the study; one for the relatives of the patients and one for the ICU physicians. The questionnaire included three sub-dimensions: informing, empathy and trust. The study included 181 patient relatives and 103 ICU physicians from three different cities and six hospitals. RESULTS Based on the results of the questionnaire, identification of the mutual expectations and substance of the messages involved in the communication process between the ICU patients' relatives and physicians was made. The gender and various disciplines of the physicians and the time of the conversation with the patients' relatives were found to affect the communication attitude towards the patient. Moreover, the age of the patient's relatives, the level of education, the physician's perception, and the contact frequency with the patient when he/she was healthy were also proven to have an impact on the communication attitude of the physician. CONCLUSION This study demonstrates the mutual expectations and substance of messages in the informing, empathy and trust sub-dimensions of the communication process between patient relatives and physicians in the ICU. The communication between patient relatives and physicians can be strengthened through a variety of training programs to improve communication skills.
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Affiliation(s)
- Faruk Cicekci
- Department of Anesthesiology, Selcuk University, Medical Faculty, Alaadin Keykubat Yerleskesi, Konya, Turkey.
| | - Numan Duran
- Scool of Foreing Languages, Selcuk University, Konya, Turkey
| | - Bunyamin Ayhan
- Department of Journalism, Selcuk University, Communication Faculty, Konya, Turkey
| | - Sule Arican
- Department of Anesthesiology, Konya Numune State Hospital, Konya, Turkey
| | - Omur Ilban
- Department of Anesthesiology, Selcuk University, Medical Faculty, Alaadin Keykubat Yerleskesi, Konya, Turkey
| | - Iskender Kara
- Department of Anesthesiology, Konya Numune State Hospital, Konya, Turkey
| | - Melda Turkoglu
- Department of Internal Medicine, Gazi University, Medical Faculty, Ankara, Turkey
| | - Fatma Yildirim
- Department of Internal Medicine, Gazi University, Medical Faculty, Ankara, Turkey
| | - Ismail Hasirci
- Department of General Surgery, Konya Training and Education Hospital, Konya, Turkey
| | - Adnan Karaibrahimoglu
- Department of Biostatistics, Suleyman Demirel University, Faculty of Medicine, Konya, Turkey
| | - Inci Kara
- Department of Anesthesiology, Selcuk University, Medical Faculty, Alaadin Keykubat Yerleskesi, Konya, Turkey
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Abstract
BACKGROUND Patient- and family-centered care permeates critical care where there are often multiple teams involved in management. A method of facilitating information sharing to support shared decision making is essential in appropriately rendering care.This study sought to determine whether incorporating family members on rounds in the intensive care unit (ICU) improves patient and family knowledge and whether doing so improves team time management and satisfaction with the process. METHODS A nonrandomized comparative before-and-after trial of incorporating family members on rounds (July to December 2009 vs January to July 2010) in a single quarternary center's surgical ICU assessed (1) family members' knowledge, (2) nurse's and physician's satisfaction with the intervention, (3) frequency and timing of family meetings, and (4) physician's workflow. RESULTS Intensive care unit demographics and use were similar between time frames. Presurvey (n = 412 family members; 49 nurses) and postsurvey (n = 427 family members; 47 nurses) were coupled with presurvey (n = 5) and postsurvey (n = 6) physicians' informal feedback. Family knowledge of the clinical course and plans increased from 146 (35.4%) of 412 to 374 (87.6%) of 427 (p < 0.0001). Nurses were nearly uniformly satisfied with planned family interaction on rounds (presurvey: 9/49 [18.4%] vs postsurvey: 46/47 [97.9%]; p < 0.0001). Family meetings per week outside of rounds substantially decreased from a mean of 5.3 ± 2.7 to 0.3 ± 0.9; p < 0.001). Goals of therapy including end-of-life care became an element frequently discussed on rounds with families (presurvey: 9.4% ± 4.7% vs postsurvey: 82.5% ± 14.8%; p < 0.0001). One intensivist was dissatisfied with the process. CONCLUSION Incorporating family members on rounds in the ICU improves communication and satisfaction and shifts the team's time away from family communication events outside of rounds, condensing most of those activities within the rounding structure. Critical care nurses and intensivists were principally satisfied with the process. LEVEL OF EVIDENCE Therapeutic, level III.
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Abstract
BACKGROUND: Relatives of intensive care unit patients who lack or have reduced capacity to consent are entitled to information and participation in decision-making together with the patient. Practice varies with legislation in different countries. In Norway, crucial decisions such as withdrawing treatment are made by clinicians, usually morally justified to relatives with reference to the principle of non-maleficence. The relatives should, however, be consulted about whether they know what the patient would have wished in the situation. RESEARCH OBJECTIVES: To examine and describe relatives' experiences of responsibility in the intensive care unit decision-making process. RESEARCH DESIGN: A secondary analysis of interviews with bereaved relatives of intensive care unit patients was performed, using a narrative analytical approach. PARTICIPANTS AND RESEARCH CONTEXT: In all, 27 relatives of 21 deceased intensive care unit patients were interviewed about their experiences from the end-of-life decision-making process. Most interviews took place in the participants' homes, 3-12 months after the patient's death. ETHICAL CONSIDERATIONS: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services and by the Regional Committee for Medical and Health Research Ethics. FINDINGS: The results show that intensive care unit relatives experienced a sense of responsibility in the decision-making process, independently of clinicians' intention of sparing them. Some found this troublesome. Three different variants of participation were revealed, ranging from paternalism to a more active role for relatives. DISCUSSION: For the study participants, the sense of responsibility reflects the fact that ethics and responsibility are grounded in the individual's relationship to other people. Relatives need to be included in a continuous dialogue over time to understand decisions and responsibility. CONCLUSION: Nurses and physicians should acknowledge and address relatives' sense of responsibility, include them in regular dialogue and help them separate their responsibility from that of the clinicians.
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Affiliation(s)
- Ranveig Lind
- UiT The Arctic University of Norway, Norway; University Hospital of North Norway, Norway
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Mahrous MS. Relating family satisfaction to the care provided in intensive care units: quality outcomes in Saudi accredited hospitals. Rev Bras Ter Intensiva 2017; 29:188-194. [PMID: 28591370 PMCID: PMC5496753 DOI: 10.5935/0103-507x.20170018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/14/2017] [Indexed: 11/20/2022] Open
Abstract
Objectives This study aims to identify the satisfaction levels of the family members of
patients in intensive care units. Methods This is a cross-sectional analytical study. General intensive care units
offer a variety of services to clinical and surgical patients. For the
purpose of this study, a trained interviewer communicated with the families
of patients, either before or after visiting hours. Results The study included 208 participants: 119 (57.2%) males and 89 (42.8%)
females. Seventy-three (35.1%) of the patients attended a private hospital,
and 135 (64.9%) attended a public hospital in the city of Al Madinah Al-
Munawarah. All of the participants were either family members or friends of
patients admitted to the intensive care units at the hospitals. The
responses of both groups yielded low scores on the satisfaction index.
However, a relatively high score was noted in response to questions 2, 6,
and 10, which concerned the care that was extended by the hospital staff to
their patients, the courteous attitude of intensive care unit staff members
towards patients, and patients' satisfaction with the medical care provided,
respectively. A very low score was obtained for item 11, which was related
to the possibility for improvements to the medical care that the patients
received. Overall, greater satisfaction with the services offered by the
public intensive care units was reported compared to the satisfaction with
the services offered by the private intensive care units. Conclusion An overall low score on the satisfaction index was obtained, and further
studies are recommended to assess the current situation and improve the
satisfaction and quality of care provided by intensive care units.
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McKenzie E, Potestio ML, Boyd JM, Niven DJ, Brundin-Mather R, Bagshaw SM, Stelfox HT. Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making. Health Expect 2017; 20:1367-1374. [PMID: 28561887 PMCID: PMC5689241 DOI: 10.1111/hex.12576] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 12/21/2022] Open
Abstract
Background Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. Objective To describe the decision‐making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list. Design We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio‐recorded, transcribed and analysed using qualitative content analysis to explore the decision‐making process for establishing consensus. Setting and participants Nine panellists including three providers, three decision makers and three family members of previously critically ill patients. Results Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the “Top 5” priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion. Conclusions Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups.
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Affiliation(s)
| | - Melissa L Potestio
- Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jamie M Boyd
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.,W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada
| | - Daniel J Niven
- Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Sean M Bagshaw
- Department of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Calgary, AB, Canada
| | - Henry T Stelfox
- Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
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Abstract
OBJECTIVES To investigate family perceptions of having a nurse participating in family conferences and to assess the psychologic well being of the same families after ICU discharge. DESIGN Mixed-method design with a qualitative study embedded in a single-center randomized study. SETTING Twelve-bed medical-surgical ICU in a 460-bed tertiary hospital. SUBJECTS One family member for each consecutive patient who received more than 48 hours of mechanical ventilation in the ICU. INTERVENTION Planned proactive participation of a nurse in family conferences led by a physician. In the control group, conferences were led by a physician without a nurse. MEASUREMENTS AND MAIN RESULTS Of the 172 eligible family members, 100 (60.2%) were randomized; among them, 88 underwent semistructured interviews at ICU discharge and 86 completed the Peritraumatic Dissociative Experiences Questionnaire at ICU discharge and then the Hospital Anxiety Depression Questionnaire and the Impact of Event Scale (for posttraumatic stress-related symptoms) 3 months later. The intervention and control groups were not significantly different regarding the prevalence of posttraumatic stress-related symptoms (52.3 vs 50%, respectively; p = 0.83). Anxiety and depression subscale scores were significantly lower in the intervention group. The qualitative data indicated that the families valued the principle of the conference itself. Perceptions of nurse participation clustered into four main themes: trust that ICU teamwork was effective (50/88; 56.8%), trust that care was centered on the patient (33/88; 37.5%), trust in effective dissemination of information (15/88; 17%), and trust that every effort was made to relieve anxiety in family members (12/88; 13.6%). CONCLUSIONS Families valued the conferences themselves and valued the proactive participation of a nurse. These positive perceptions were associated with significant anxiety or depression subscale scores but not with changes in posttraumatic stress-related symptoms.
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Sedation versus no sedation: Are there differences in relatives' satisfaction with the Intensive Care Unit? A survey study based on data from a randomised controlled trial. Intensive Crit Care Nurs 2017; 39:59-66. [PMID: 27887881 DOI: 10.1016/j.iccn.2016.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/17/2016] [Accepted: 08/20/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Currently there is a trend towards less or no use of sedation of mechanically ventilated patients. Still, little is known about how different sedation strategies affect relatives' satisfaction with the Intensive Care Unit (ICU). AIM To explore if there was a difference in relatives' personal reactions and the degree of satisfaction with information, communication, surroundings, care and treatment in the ICU between relatives of patients who receive no sedation compared with relatives of patients receiving sedation during mechanical ventilation in the ICU. METHOD A survey study using a questionnaire with 39 questions was distributed to relatives of mechanically ventilated patients, who had been randomised to either sedation with daily wake up or no sedation. RESULTS Forty-nine questionnaires were sent out and 36 relatives answered. The response rate was 73%. We found no differences in relatives' personal reactions or in the degree of satisfaction with information, communication, care and treatment in the ICU between relatives of patients in the two groups. Relatives of patients treated with no sedation felt more bothered by disturbances in the surroundings compared with relatives of patients who were sedated (p=0.03). CONCLUSION Treating the patient during mechanical ventilation with no sedation does not affect relatives' satisfaction adversely.
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Can patient and family satisfaction influence the management of department of intensive care medicine? Med Intensiva 2017; 41:67-69. [PMID: 28209291 DOI: 10.1016/j.medin.2016.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/23/2022]
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Fanning JB, Farkas CM, DeWitt PM, Webster THG, Burnam J, Piras SE, Schenck D, Miller A. Obstacles to Shared Expectations in a Burn Intensive Care Unit. QUALITATIVE HEALTH RESEARCH 2017; 27:351-362. [PMID: 26631676 DOI: 10.1177/1049732315616619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Critical care patients are dependent on the health care team and their family members to effect care goals that are consistent with their core values and wishes. This study aimed to identify and understand how obstacles to communication affect these two disparate groups. Ten burn intensive care unit (BICU) care team and 20 family members participated in in-depth semistructured interviews. A two-cycle coding, inductive analytical approach was used to derive three obstacle metathemes: family engagement, information exchange, and process transparency and standardization. However, care team and family members' themes within each metatheme were different. Although the thematic structure was derived inductively, our findings in retrospect appeared to be consistent with Law's four resistances associated with actor-networks. From this perspective, actor-network theory provides a plausible explanation for perceived obstacles and may, in the future, guide the development of interventions to improve shared agency across networks.
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Affiliation(s)
- Joseph B Fanning
- 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Paula M DeWitt
- 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - John Burnam
- 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan E Piras
- 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Schenck
- 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anne Miller
- 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA
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The Impact of Resident Training on Communication with Families in the Intensive Care Unit. Resident and Family Outcomes. Ann Am Thorac Soc 2017; 13:512-21. [PMID: 26989925 DOI: 10.1513/annalsats.201508-495oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE In high-acuity settings such as intensive care units (ICUs), the quality of communication with patients' families is a particularly important component of care. Evidence shows that ICU communication is often inadequate and can negatively impact family outcomes. OBJECTIVES To assess the impact of a communication training program on resident skills in communicating with families in an ICU and on family outcomes. METHODS We conducted a prospective, single-site educational intervention study. The intervention featured a weekly required communication training program (4 h total) during the ICU rotation, which included interactive discussion, and role play with immediate feedback from simulated family members. All internal medicine residents on ICU rotation between July 2012 and July 2014 were invited to participate in the study. Family members who had a meeting with an enrolled resident were approached for a survey or interview. The primary outcome was family ratings of how well residents met their informational and emotional needs. MEASUREMENTS AND MAIN RESULTS The response rate for the resident baseline survey was 93% (n = 149 of 160), and it was 90% at postcourse and 84% at 3-month follow-up. Of 303 family members approached, 237 were enrolled. Enrolled family members who had a confirmed meeting with a resident were eligible to complete a survey or interview. The completion rate was 86% (n = 82 of 95). Family members were more likely to describe residents as having "fully met" (average rating of 10/10 on 0-10 scale) their informational and emotional needs when the resident had completed two or three course sessions (84% of family members said conversation with these residents "fully met" their needs), as compared with residents who had taken one session or no sessions (25% of family members said needs were "fully met") (P < 0.0001). Residents described improvements across all domains. All differences are statistically significant, most with large effect sizes. CONCLUSIONS At our institution, an on-site communication training program designed for integration into medical residency programs was associated with strongly positive family member outcomes and significant improvements in residents' perceived skills. This intervention may serve to prepare residents for optimal communications with patients and family members in ICUs and elsewhere.
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Rensen A, van Mol MM, Menheere I, Nijkamp MD, Verhoogt E, Maris B, Manders W, Vloet L, Verharen L. Quality of care in the intensive care unit from the perspective of patient's relatives: development and psychometric evaluation of the consumer quality index 'R-ICU'. BMC Health Serv Res 2017; 17:77. [PMID: 28118840 PMCID: PMC5260020 DOI: 10.1186/s12913-016-1975-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 12/31/2016] [Indexed: 11/11/2022] Open
Abstract
Background The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient’s relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index ‘Relatives in Intensive Care Unit’ (CQI ‘R-ICU’). The CQI ‘R-ICU’ measures the perceived quality of care from the perspective of patients’ relatives, and identifies aspects of care that need improvement. Methods The CQI ‘R-ICU’ was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients’ relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis. Results Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire’s vocabulary. The response rate of patients’ relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: ‘Communication’ (α = .80) and ‘Participation’ (α = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients’ relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and involvement in decision-making on the medical treatment of the patient. Conclusions The CQI ‘R-ICU’ evaluates quality of care from the perspective of relatives of intensive care patients and provides practical information for quality assurance and improvement programs. The development and psychometric evaluation of the CQI ‘R-ICU’ led to a draft questionnaire, sufficient to justify further research into the reliability, validity, and the discriminative power of the questionnaire. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1975-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ans Rensen
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands.
| | - Margo M van Mol
- Department of Intensive Care, Erasmus MC, University Medical Center's, Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ilse Menheere
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands
| | - Marjan D Nijkamp
- Faculty of Psychology and Educational Sciences-Open University of the Netherlands, Valkenburgerweg 177, 6419 AT, Heerlen, The Netherlands
| | - Ellen Verhoogt
- Medical Center Spaarne Gasthuis, Vondelweg 999, 2026 BW, Haarlem, Netherlands
| | - Bea Maris
- Medical Center Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - Willeke Manders
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands
| | - Lilian Vloet
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands.,IQ scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisbeth Verharen
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands
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Preferences of Current and Potential Patients and Family Members Regarding Implementation of Electronic Communication Portals in Intensive Care Units. Ann Am Thorac Soc 2016; 13:391-400. [PMID: 26700656 DOI: 10.1513/annalsats.201509-638oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The quality of communication with patients and family members in intensive care units (ICUs) is a focus of current interest for clinical care improvement. Electronic communication portals are commonly used in other healthcare settings to improve communication. We do not know whether patients and family members desire such portals in ICUs, and if so, what functionality they should provide. OBJECTIVES To define interest in and desired elements of an electronic communication portal among current and potential ICU patients and their family members. METHODS We surveyed, via an Internet panel, 1,050 English-speaking adults residing in the United States with a personal or family history of an ICU admission within 10 years (cohort A) and 1,050 individuals without a history of such admission (cohort B). We also administered a survey instrument in person to 105 family members of patients currently admitted to ICUs at an academic medical center in Boston (cohort C). MEASUREMENTS AND MAIN RESULTS Respondents, especially current ICU family members, supported an electronic communication portal, including access via an electronic tablet. They wanted at least daily updates, one-paragraph summaries of family meetings including a list of key decisions made, and knowledge of the role and experience of treating clinicians. Overall, they preferred detailed rather than "big picture" information. Respondents were generally comfortable sharing information with their family members. Preferences regarding a communication portal varied significantly by age, sex, ethnicity, and prior experience with ICU hospitalization. CONCLUSIONS Electronic communication portals appear welcome in contemporary ICUs. Frequent updates, knowledge about the professional qualifications of clinicians, detailed medical information, and documentation of family meetings are particularly desired.
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Noome M, Beneken Genaamd Kolmer DM, van Leeuwen E, Dijkstra BM, Vloet LCM. The role of ICU nurses in the spiritual aspects of end-of-life care in the ICU: an explorative study. Scand J Caring Sci 2016; 31:569-578. [PMID: 27862140 DOI: 10.1111/scs.12371] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/30/2016] [Indexed: 01/05/2023]
Abstract
AIM The aim of this study was to examine the role and responsibilities of intensive care unit (ICU) nurses regarding the spiritual aspects of end-of-life care in the ICU, from the chaplains' perspectives. METHOD An explorative study including inductive thematic analysis was used. Two focus group interviews with in total eleven chaplains working in several Dutch ICUs were performed. RESULTS The focus group interviews resulted in five themes: (i) awareness of ICU nurses, (ii) communication, (iii) nursing interventions, (iv) multidisciplinary care and (v) education. In total, twenty recommendations were formulated. CONCLUSIONS This explorative study provides an overview of the perspectives of chaplains about the role of ICU nurses during end-of-life care, specified to spiritual care. Chaplains mentioned different roles, responsibilities and competences which are needed for ICU nurses to give spiritual care. These roles, responsibilities and competences included giving spiritual care to patients and families as standard care. Chaplains agreed that ICU nurses should start and maintain a dialogue with patient and families, but that it is also important to be aware of one's own spiritual background. However, education about spiritual care is needed to establish this. It could be recommended to educate ICU nurses during their ICU training or retraining about spiritual care and reflection.
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Affiliation(s)
- Marijke Noome
- Bachelor of Nursing, The Hague University of Applied Sciences, The Hague, The Netherlands.,Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Research Department Informal Care, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Deirdre M Beneken Genaamd Kolmer
- Research Department Informal Care, The Hague University of Applied Sciences, The Hague, The Netherlands.,Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Evert van Leeuwen
- Scientific Institute for Quality of Healthcare, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Boukje M Dijkstra
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Intensive Care Unit, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Lilian C M Vloet
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Scientific Institute for Quality of Healthcare, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Schram AW, Hougham GW, Meltzer DO, Ruhnke GW. Palliative Care in Critical Care Settings: A Systematic Review of Communication-Based Competencies Essential for Patient and Family Satisfaction. Am J Hosp Palliat Care 2016; 34:887-895. [PMID: 27582376 DOI: 10.1177/1049909116667071] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development. METHODS Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar. RESULTS Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified. CONCLUSION Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.
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Affiliation(s)
- Andrew W Schram
- 1 Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - David O Meltzer
- 3 Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.,4 Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA
| | - Gregory W Ruhnke
- 3 Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
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Pagnamenta A, Bruno R, Gemperli A, Chiesa A, Previsdomini M, Corti F, Merlani P, Cottini S, Llamas M, Rothen HU. Impact of a communication strategy on family satisfaction in the intensive care unit. Acta Anaesthesiol Scand 2016; 60:800-9. [PMID: 26823125 DOI: 10.1111/aas.12692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/28/2015] [Accepted: 12/29/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Family satisfaction of critically ill patients has gained increased interest as important indicator to evaluate the quality of care in the intensive care unit (ICU). The family satisfaction in the ICU questionnaire (FS-ICU 24) is a well-established tool to assess satisfaction in such settings. We tested the hypothesis that an intervention, aiming at improved communication between health professionals and patients' next of kin in the ICU improves family satisfaction, as assessed by FS-ICU 24. METHODS Using a multicenter before-and-after study design, we evaluated medium-term effectiveness of VALUE, a recently proposed strategy aiming at improved communication. Satisfaction was assessed using the FS-ICU 24 questionnaire. Performance-importance plots were generated in order to identify items highly correlated with overall satisfaction but with low individual score. RESULTS A total of 163 completed family questionnaires in the pre-intervention and 118 in the post-intervention period were analyzed. Following the intervention, we observed: (1) a non-significant increase in family satisfaction summary score and sub-scores; (2) no decline in any individual family satisfaction item, and (3) improvement in items with high overall impact on satisfaction but quoted with low degree of satisfaction. CONCLUSION No significant improvement in family satisfaction of critically ill adult patients could be found after implementing the VALUE strategy. Whether these results are due to insufficient training of the new strategy or a missing effect of the strategy in our socio-economic environment remains to be shown.
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Affiliation(s)
- Alberto Pagnamenta
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
- Unit of Clinical Epidemiology of EOC; Bellinzona Switzerland
| | - Roberta Bruno
- Swiss Association of Counselling; Zurich Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Health Policy; Lucerne University; Lucerne Switzerland
- Swiss Paraplegic Research; Nottwil Switzerland
| | - Alessandro Chiesa
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
- Surgical Intensive Care Medicine; University Hospital Zurich; Zurich Switzerland
| | - Marco Previsdomini
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
| | - Fabio Corti
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
| | - Paolo Merlani
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
- Department of Anesthesiology; Pharmacology and Intensive Care; University Hospital Geneva; Geneva Switzerland
| | - Silvia Cottini
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
- Surgical Intensive Care Medicine; University Hospital Zurich; Zurich Switzerland
| | - Michael Llamas
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
| | - Hans Ulrich Rothen
- Department of Intensive Care Medicine; Bern University Hospital (Inselspital); Bern Switzerland
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Cox CE, Curtis JR. Using Technology to Create a More Humanistic Approach to Integrating Palliative Care into the Intensive Care Unit. Am J Respir Crit Care Med 2016; 193:242-50. [PMID: 26599829 DOI: 10.1164/rccm.201508-1628cp] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A decade ago, the major obstacles to integration of palliative care into the intensive care unit (ICU) were the limited number of providers trained in palliative care, an immature evidence base, and a lack of appreciation for the importance of palliative care in the ICU. In 2016, the palliative care workforce has expanded markedly and there is growing appreciation of the benefits of palliative care, whether provided by a generalist (intensivist, nurse, social worker) or palliative care specialist. However, there is evidence that the quality of ICU-based palliative care is often suboptimal. A major barrier to more broadly addressing this quality problem is the lack of scalable ICU-based palliative care models that use technology to deliver efficient, collaborative palliative care in the ICU setting to the right patient at the right time. To address these challenges, we first review strengths and limitations of current care models as the basis for our novel conceptual framework that uses the electronic health record as a platform on which external innovations can be built, including: (1) screening for patients at risk for poor outcomes, (2) integrating patient- and family-reported needs, (3) personalizing care, and (4) directing generalist versus specialist triage algorithms. In the approaches considered, we describe current challenges and propose specific solutions that use technology to improve the quality of the human interaction in a stressful, complex environment.
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Affiliation(s)
- Christopher E Cox
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.,2 Program to Support People and Enhance Recovery, Duke University, Durham, North Carolina; and
| | - J Randall Curtis
- 3 Cambia Palliative Care Center of Excellence, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
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Salins N, Deodhar J, Muckaden MA. Intensive Care Unit death and factors influencing family satisfaction of Intensive Care Unit care. Indian J Crit Care Med 2016; 20:97-103. [PMID: 27076710 PMCID: PMC4810940 DOI: 10.4103/0972-5229.175942] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Family satisfaction of Intensive Care Unit (FS-ICU) care is believed to be associated with ICU survival and ICU outcomes. A review of literature was done to determine factors influencing FS-ICU care in ICU deaths. RESULTS Factors that positively influenced FS-ICU care were (a) communication: Honesty, accuracy, active listening, emphatic statements, consistency, and clarity; (b) family support: Respect, compassion, courtesy, considering family needs and wishes, and emotional and spiritual support; (c) family meetings: Meaningful explanation and frequency of meetings; (d) decision-making: Shared decision-making; (e) end of life care support: Support during foregoing life-sustaining interventions and staggered withdrawal of life support; (f) ICU environment: Flexibility of visiting hours and safe hospital environment; and (g) other factors: Control of pain and physical symptoms, palliative care consultation, and family-centered care. Factors that negatively influenced FS-ICU care were (a) communication: Incomplete information and unable to interpret information provided; (b) family support: Lack of emotional and spiritual support; (c) family meetings: Conflicts and short family meetings; (d) end of life care support: Resuscitation at end of life, mechanical ventilation on day of death, ICU death of an elderly, prolonged use of life-sustaining treatment, and unfamiliar technology; and (e) ICU environment: Restrictive visitation policies and families denied access to see the dying loved ones. CONCLUSION Families of the patients admitted to ICU value respect, compassion, empathy, communication, involvement in decision-making, pain and symptom relief, avoiding futile medical interventions, and dignified end of life care.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
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