Effect of Programmed Family Presence in Coronary Care Units on Patients' and Families' Anxiety

Effect of family-centered care on the anxiety levels among family members of patients undergoing cardiac surgery: a randomized controlled trial

Background

The present study aims to determine the effect of family-centered care on anxiety levels among family members of patients undergoing cardiac surgery.

Materials and methods

This study was a randomized clinical trial study that was conducted on the families of Iranian cardiac surgery patients. In the intervention group, family-centered care was implemented, and the content of the intervention included providing informational and emotional support to the family member and the family member's participation in patient care according to the set framework.

Results

A total of 144 family members of patients undergoing cardiac surgery were included in this study. Among the 144 family members, 71 were in the intervention group, and 73 were in the control group. The changes in the state anxiety score before and after the intervention were significant between the two groups, and the changes were higher in the control group (P=0.043). Also, there was no significant difference in the changes in trait anxiety before and after the intervention between the two groups (P>0.05).

Conclusion

In general, the high prevalence of anxiety in patients' families has negative functional consequences on both patients and their families. To reduce the level of anxiety, special attention should be paid to knowing the effective factors and appropriate coping methods. Nevertheless, it is important to note that additional research is warranted to delve deeper into this matter in future studies.

[Effect of an Intervention Using Voice Recording of a Family Member on Patients Undergoing Mechanical Ventilator Weaning Process]

PURPOSE

This study aimed to determine the impact of an intervention using voice recording of family members on pain, anxiety, and agitation in patients undergoing weaning from mechanical ventilation.

METHODS

A randomized control pre-post experimental design was implemented to 53 participants, with 27 and 26 participants in the experimental and control groups, respectively. A 70-second voice recording of a family member, repeated three times at 10-minute intervals was used as an intervention for the experimental group. Meanwhile, participants in the control group used headset for 30 minutes. Structured instruments were utilized to measure pain, anxiety, agitation, and the weaning process. Wilcoxon Signed Ranks test and the Mann-Whitney U test, or χ² test, were used for data analysis.

RESULTS

The experimental group exhibited significant decrease in pain (Z = -3.53, p < .001), anxiety (t = 5.45, p < .001), and agitation (Z = -2.99, p = .003) scores compared with those of the control group. However, there was no significant difference between groups in the weaning process' simplification (χ² = 0.63, p = .727).

CONCLUSION

Intervention using family members' voice recording effectively reduces pain, anxiety, and agitation in patients undergoing weaning from mechanical ventilation. This can be actively utilized to provide a more comfortable process for patients.

Strategies Used by Nurses to Maintain Person-Family Communication during the COVID-19 Pandemic: A Scoping Review

Background: The COVID-19 pandemic made nurse-patient-family communication more difficult, reducing the understanding of the patient's wishes and current care history. COVID-19 challenged healthcare teams to develop strategies to address these changes and provide more integrated care using the technology at their disposal. So, this study aims to map the strategies used by nurses to maintain communication between the person hospitalized with COVID-19 and the family to understand which communication technologies were most used to maintain communication between the person and the family. Methods: A Scoping Review, according to the recommendations of the Joanna Briggs Institute [JBI] with the Preferred Reporting Items for Scoping Review extension (PRISMA-ScR), research conducted between September 2022 and January 2023. The search was conducted in the databases: Latin American and Caribbean Literature in Health Sciences (LILACS); Cumulative Index of Nursing and Allied Health Literature (CINAHL); Scientific Electronic Library Online (SciELO); Medical Literature Analysis and Retrieval System Online (Medline), using the descriptors: family, communication, nurses, hospitals and COVID-19, and the Boolean operators "AND". The inclusion criteria were: original articles, in Portuguese, English, and Spanish, published from 2020 onwards, with access to full and free text. Results: It was found that most of the communication was unstructured with the family. The technologies most used by nurses were the telephone with video calls from the patients themselves and even from health professionals to maintain communication between the patient and the family. Conclusions: Communication between patients and families became essential during the pandemic, as it became a vital lifeline of human connection that supported the mental health of patients and their families. This study was not registered.

Strategies for Virtual Bereavement Care

ABSTRACT

The contagiousness of some illnesses (e.g., COVID-19) limits the ways in which families can interact with their dying loved ones who have been admitted to the hospital, especially in the intensive care unit. As a result, nurses have developed culturally relevant strategies for virtual bereavement care for patients and families predeath, perideath, and postdeath. Specific ways nurses can support, communicate, and facilitate meaningful rituals when patients die in isolation are provided in this article.

The effect of structured virtual patient visits (sVPVs) on COVID-19 patients and relatives' anxiety levels in intensive care unit

AIM AND OBJECTIVES

To determine the effect of structured Virtual Patient Visits (sVPVs) on the anxiety, satisfaction, hospital anxiety and depression levels of intensive care unit (ICU) COVID-19 patients and their relatives.

BACKGROUND

There is no evidence regarding the direct effect of virtual patient visits in the ICU.

DESIGN

The STROBE statement guided this study. This investigator-initiated, prospective and single-centre study included COVID-19 patients and their relatives in an adult ICU between July and December 2020. We implemented daily sVPVs between all patients and their relatives. The study's primary outcome was the daily anxiety levels of patients and relatives immediately before and after sVPVs. The secondary outcomes were as follows: 1) hospital anxiety (HADS-A) and depression (HADS-D) levels during admission to and after discharge from the ICU and 2) satisfaction levels regarding the ICU and sVPVs of patients' relatives.

RESULTS

A total number of 301 daily sVPVs were conducted between 50 patients and their relatives. There was a significant difference between daily anxiety levels before and after sVPVs in both patients (2.97 vs. 1.49) and their relatives (5.70 vs. 3.53; p > .05). Whereas the anxiety levels of patients with basic face or high flow nasal cannula and non-invasive mechanical ventilation decreased statistically significantly more than those with IMV after a sVPV (p < .001), there was not a significant difference in decreased anxiety levels of patients' relatives according to the type of respiratory support provided to the patient (p > .05). HADS-A levels of relatives decreased statistically significantly after discharge/death. There was no statistically significant difference in HADS-A and HADS-D levels after discharge/death between the relatives of patients who died or did not die (p > .05). Furthermore, the overall ICU satisfaction rates were statistically significantly lower in relatives of patients who died than those who did not die (p < .05).

CONCLUSION

Regardless of whether the patients were intubated, sVPVs reduced the anxiety levels of all patients and relatives. The sVPV programme offered emotional support to patients and family members, with high levels of satisfaction, as well as provided regular informative updates and the opportunity for daily visits or final goodbyes.

RELEVANCE FOR CLINICAL PRACTICE

The sVPV programme is essential for all ICUs during the COVID-19 pandemic.

The effect of the family presence on anxiety and agitation of patients under mechanical ventilation after open heart surgery: a randomized clinical trial

Background

Family-centered care has been considered as a philosophy of care. Family presence in intensive care units (ICUs), especially in the acute phase of the disease is controversial. This study has been carried out in order to determine the effect of the family presence on anxiety and agitation in patients undergoing coronary artery bypass grafting (CABG).

Materials and methods

In a clinical trial, 70 patients were randomly allocated into groups of experimental and control. In the experimental group, during the weaning process from the mechanical ventilation, a family member was present at the bedside. The degree of anxiety and Richmond’s Agitation and Sedation Scale (RASS) were compared in seven consecutive time stages, including the time of entry into the ICU, the first respiratory drive, the family entrance, 20 min and 1 h after the presence of the family member, the time of extubation, and 1 h after extubation.

Results

There was a significant difference between the two groups in the mean scores of the anxiety scale in the first (P =0.008), second (P=0.002), and third stages (P =0.005). This difference was not significant in the fourth to seventh stages (P>0.05). As the baseline anxiety levels were different, a covariate adjustment was used for comparisons between treatments, adjusting the main analyses for baseline anxiety levels. Analysis showed that groups were not different. Also, there was no significant difference in the mean scores of RASS between the two experimental and control groups at any of the seven stages (P> 0.05).

Conclusion

According to the findings of the present study, the presence of a family member does not reduce the level of anxiety and agitation of patients undergoing cardiac surgery. However, it can be concluded that this intervention is feasible in acute and complex situations after open heart surgeries.

Trial registration

This study has been registered in the Iranian Registry of Clinical Trials with the code IRCT201609014299N4.

Effect of programmed nursing combined with cognitive behavioral intervention on clinical nursing effect and neurological function of patients with intracerebral hemorrhage

OBJECTIVE

To investigate the effect of programmed nursing combined with cognitive behavioral intervention on clinical efficacy and neurological function of patients with intracerebral hemorrhage (ICH).

METHODS

In this retrospective study, 96 patients with ICH admitted to our hospital were enrolled and divided into a programmed group and a joint group, with 48 cases in each group. Patients in the programmed group were treated with programmed nursing while those in the joint group were given cognitive behavior intervention based on programmed nursing, for 28 days. The Fugl-Meyer (FM) Assessment Scale was used to evaluate the motor function of patients, the Barthel index to analyze the activities of daily living (ADL), and the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Outcome Scale (GOS) to assess the neurological function. The quality of life of patients was evaluated by the World Health Organization quality of life Brief Version (WHOQOL-BREF), and the nursing satisfaction of patients or their families was investigated by the self-made satisfaction scale. The incidence of adverse reactions during treatment was recorded and compared.

RESULTS

FM Assessment Scale and Barthel index did not differ significantly between the two groups before nursing (t_Fugl-Meyer =0.059, t_Barthel =0.033, both P>0.05); after nursing, the two scores increased in both groups, with higher scores in the joint group (t_Fugl-Meyer =3.331, t_Barthel =2.735, both P<0.05). Before nursing, there was no difference in NIHSS and GOS scores between the two groups (t_NIHSS =0.257, t_GOS =0.553, both P>0.05); after nursing, however, the NIHSS score decreased and the GOS score increased in both groups, with statistically significant differences between the two groups (t_NIHSS =5.158, t_GOS =5.303, both P<0.05). The total effective rate in the joint group was significantly higher than that in the programmed group (91.67% vs. 77.08%; χ²=4.511, P=0.034). No significant difference was observed in the World Health Organization Quality of Life Scale Brief Version (WHOQOL BREF) score between the two groups (t=0.049, P=0.960) before nursing; after nursing, the score increased significantly in both groups, with a significant difference between the two groups (t=15.970, P<0.001). The satisfaction was 95.83% in the joint group, which was higher than that of 83.33% in the programmed group (χ²=3.913, P=0.048). The joint group also had fewer adverse reactions than the programmed group (χ²=7.401, P=0.007).

CONCLUSION

Programmed nursing combined with cognitive behavioral intervention can improve the clinical efficacy of patients with ICH, improve limb motor ability, and reduce neurological deficits, with high safety.

A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic

To create evidence-based consensus statements for restricted ICU visitation policies to support critically ill patients, families, and healthcare professionals during current and future pandemics.

DESIGN

Three rounds of a remote modified Delphi consensus process.

SETTING

Online survey and virtual polling from February 2, 2021, to April 8, 2021.

SUBJECTS

Stakeholders (patients, families, clinicians, researchers, allied health professionals, decision-makers) admitted to or working in Canadian ICUs during the coronavirus disease 2019 pandemic.

MEASUREMENTS AND MAIN RESULTS

During Round 1, key stakeholders used a 9-point Likert scale to rate experiences (1-not significant, 9-significant impact on patients, families, healthcare professionals, or patient- and family-centered care) and strategies (1-not essential, 9-essential recommendation for inclusion in the development of restricted visitation policies) and used a free-text box to capture experiences/strategies we may have missed. Consensus was achieved if the median score was 7-9 or 1-3. During Round 2, participants used a 9-point Likert scale to re-rate experiences/strategies that did not meet consensus during Round 1 (median score of 4-6) and rate new items identified in Round 1. During Rounds 2 and 3, participants ranked items that reached consensus by order of importance (relative to other related items and experiences) using a weighted ranking system (0-100 points). Participants prioritized 11 experiences (e.g., variability of family's comfort with technology, healthcare professional moral distress) and developed 21 consensus statements (e.g., communicate policy changes to the hospital staff before the public, permit visitors at end-of-life regardless of coronavirus disease 2019 status, creating a clear definition for end-of-life) regarding restricted visitation policies.

CONCLUSIONS

We have formulated evidence-informed consensus statements regarding restricted visitation policies informed by diverse stakeholders, which could enhance patient- and family-centered care during a pandemic.

Communication and Virtual Visiting for Families of Patients in Intensive Care during the COVID-19 Pandemic: A UK National Survey

Rationale: Restriction or prohibition of family visiting intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic poses substantial barriers to communication and family- and patient-centered care. Objectives: To understand how communication among families, patients, and the ICU team was enabled during the pandemic. The secondary objectives were to understand strategies used to facilitate virtual visiting and associated benefits and barriers. Methods: A multicenter, cross-sectional, and self-administered electronic survey was sent (June 2020) to all 217 UK hospitals with at least one ICU. Results: The survey response rate was 54%; 117 of 217 hospitals (182 ICUs) responded. All hospitals imposed visiting restrictions, with visits not permitted under any circumstance in 16% of hospitals (28 ICUs); 63% (112 ICUs) of hospitals permitted family presence at the end of life. The responsibility for communicating with families shifted with decreased bedside nurse involvement. A dedicated ICU family-liaison team was established in 50% (106 ICUs) of hospitals. All but three hospitals instituted virtual visiting, although there was substantial heterogeneity in the videoconferencing platform used. Unconscious or sedated ICU patients were deemed ineligible for virtual visits in 23% of ICUs. Patients at the end of life were deemed ineligible for virtual visits in 7% of ICUs. Commonly reported benefits of virtual visiting were reducing patient psychological distress (78%), improving staff morale (68%), and reorientation of patients with delirium (47%). Common barriers to virtual visiting were related to insufficient staff time, rapid implementation of videoconferencing technology, and challenges associated with family members' ability to use videoconferencing technology or access a device. Conclusions: Virtual visiting and dedicated communication teams were common COVID-19 pandemic innovations addressing the restrictions to family ICU visiting, and they resulted in valuable benefits in terms of patient recovery and staff morale. Enhancing access and developing a more consistent approach to family virtual ICU visits could improve the quality of care, both during and outside of pandemic conditions.