How to communicate with family members of the critically ill in the intensive care unit: A scoping review

OBJECTIVE

To map the existing approaches to communication with family members of the critically ill in the intensive care unit and the corresponding implementation requirements and benefits.

METHODS

We conducted a scoping review in February 2022 by searching PubMed, CINAHL, APA PsycINFO, and Cochrane Library for articles published between 2000 and 2022. We included records of all designs that met our inclusion criteria and applied frequency counts and qualitative coding.

RESULTS

The search yielded 3749 records, 63 met inclusion criteria. The included records were of an interventional (43 %) or observational (14 %) study design or review articles (43 %), and provided information in three categories: communication platforms, strategies, and tools. For implementation in the intensive care unit, the approaches required investing time and resources. Their reported benefits were an increased quality of communication and satisfaction among all parties involved, improved psychological outcome among family members, and reduced intensive care unit length of stay and costs.

CONCLUSION

The current approaches to communication with patients' family members offer insights for the development and implementation of communication pathways in the intensive care unit of which the benefits seem to outweigh the efforts. Structured interprofessional frameworks with standardised tools based on empathic communication strategies are encouraged.

Implementing a Comfort Care Cart: A Quality Improvement Nurse-Driven Initiative in the Intensive Care Unit

The field of critical care nursing is multidimensional and filled with opportunities to bring change to current practice. In the United States, nearly 13% of patients (range, 8%-24%) admitted to an intensive care unit (ICU) die during or after the admission (https://www.dartmouthatlas.org/interactive-apps/end-of-life-care/). Critical care nurses provide care at every stage of acute and chronic illness. Often this includes care of the patient and family at end of life, guided by palliative care principles supported by the national guidelines including the American Association of Critical Care (Dimens Crit Care Nurs 2017;36(2):110-115). While enrolled in the final registered nurse-to-bachelor of science in nursing (RN-to-BSN) course, students are challenged to complete a quality improvement (QI) project. The project leader noted a clinical problem in the ICU. The landmark Dying in America report, as well as published theories on comfort, and the Institute for Healthcare Improvement (IHI) Open School Plan-Do-Study-Act (PDSA) model were used as the theoretical foundation for a clinical practice change. This assignment was the impetus to provide items at the bedside using a comfort cart. Description of this nurse-driven pilot project initiative includes a replicable guide of implementing a comfort care cart, transforming the patient's room into a home-like atmosphere for the families at the bedside.

Critical Care Registered Nurses' Preparedness in the Provision of End-of-Life Care

BACKGROUND

The number of deaths in critical care units continues to rise as patients are living longer with chronic illnesses; however, critical care registered nurses report feelings of unpreparedness in the provision of end-of-life (EOL) care.

OBJECTIVES

To understand and find meaning of critical care registered nurses' preparedness in the provision of EOL care.

METHODS

A qualitative interpretive description study was conducted to allow for rich, descriptive detail through the participants' eyes. Semistructured one-on-one interviews were conducted with 12 participants. Constant comparative method was used to analyze the data.

RESULTS

According to the participants, to be prepared to provide EOL care, the nurses need to understand their personal beliefs about death and dying; be able to provide care to both patient and family; combine knowledge based on education, personal and professional experience, and support resources; balance the ongoing dialogue between their professional and personal role as a registered nurse; and find ways to make sense of the dying experience, specifically through closure.

DISCUSSION

Ultimately, the provision of EOL is contextual and will vary, requiring the critical care registered nurse to adapt to each situation utilizing the tools learned and experienced to promote patient, family, and nurse comfort. Improvements to nursing education and nursing practice are warranted to expose students and nurses to more EOL care experiences while also providing the tools and support resources during the provision of EOL care.

Family participation in the care of older adult patients admitted to the intensive care unit: A scoping review

BACKGROUND

Family members' participation in care is internationally advocated as a way to improve patient outcomes admitted to the intensive care unit (ICU).

OBJECTIVE

to provide an overview of current understandings about family participation in the care of older adult patients admitted to ICU.

DESIGN, DATA SOURCES, AND METHODS

The Arksey and O'Malley's framework for scoping review was used. We searched PubMed, CINAHL, EmBase, Scopus, and Cochrane from their inception until 10 October 2019 to answer this question: What are the dimensions, prerequisites, facilitators, barriers, and consequences of family member's participation in the care of older adult patient admitted to ICU?

RESULTS

Of 3410 search results, 33 articles were included (10 descriptive; 3 interventional or quality improvement project; 12 qualitative; 5 reviews; 1 expert opinion; 1 evidence-practice recommendation and 1 clinical guideline). The included studies were conducted internationally (n = 7), USA (n = 8), Canada (n = 3), France (n = 2), Britannia, Australia (n = 6), (n = 2), and Sweden (n = 5). No article from Asian and African countries was retrieved. The supporting level of evidence for most studies (28 out of 33) was low.

CONCLUSIONS

This review showed that family members could participate in the provision of physical and non-physical care (emotional, mental, cognitive, and psychosocial) to older adult patients admitted to ICU. Their participation in ICU care has the potential to improve the physical, emotional, psychological and psychological outcomes of older adult patients and their family members as well as reduce the burden of the healthcare system. The barriers were grouped into patient-related factors, ICU staff-related factors, family-related factors, and ICU setting-related factors. In addition, several facilitators of participation in ICU care were discussed.

THE IMPLICATION FOR FUTURE RESEARCH

This review showed a lack of experimental studies on the effectiveness of family members' participation in ICU care for the patient, family, and care system. This provides an opportunity for future research to develop and test interventions based on the multiple dimensions described in this paper.

The decision-making process in families of terminal ICU patients

Abstract The objective of this research is to investigate family members’ perceptions as to the end-of-life decision-making process in an ICU. The authors conducted a qualitative descriptive study in which they interviewed six family members of critically ill patients admitted to the ICU of a private hospital. Five categories of analysis emerged from the examination of the material. This study will discuss two of those categories: the decision-making process and the relationship with the medical staff. The results indicate that family members were satisfied with communication with the medical staff, an important aspect for the decision-making process. Within this context, the shared model, prioritization of palliative care and identification of futile treatments prevailed, aimed at ensuring the patient’s comfort and dignity at the end of life. The results also reveal the need for integration of palliative care in ICUs, particularly in end-of-life situations.

Contingency Help: The Main Strategy of Iranian Nurses in Dealing With the Family of the End-of-Life Patients

Families are struggling with many challenges in the final stages of patient life. It is important to understand what actions nurses do for the family of the end-of-life (EOL) patients. This study aimed to explain the main strategy of nurses' dealing with the family of the EOL patients. Data were analyzed using conventional content analysis. Semistructured interviews were conducted on 32 nurses from hospitals in Tehran. Nurses used six measures of explaining the bitter reality, effective communication, management of violence, referral, consolation, and reinforcement. "Contingency help" was conceptualized as the main strategy. Nurses through "contingency help" were involved in solving the emotional, physical, financial, and spiritual needs of the family. Nurses will be able to apply the results of this study to the development of care policies for the family of the EOL patients.

Seeing the Patient and Family Through: Nurses and Physicians Experiences With Withdrawal of Life-Sustaining Therapy in the ICU

Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians’ experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.

Understanding End-of-Life Decision-Making Terminology Among African American Older Adults

The purpose of the current study was to examine understanding of end-of-life (EOL) decision-making terminology among family caregivers of African American older adults with dementia. This qualitative descriptive study was part of a larger mixed-methods study from which a subset of caregivers (n = 18) completed interviews. Data were analyzed using descriptive statistics and content analyses guided by methods of qualitative analysis. Caregiver interpretation of EOL decision-making terminology varied between associations before and/or after death. EOL decision making was most often a family decision, based on past experiences, and included reliance on resources such as faith or spirituality and health care providers. Patients and families attach meaning to health care terms that should be aligned with health care providers' understanding of those terms. Results provide insight to improve EOL decision making in this population via tailored interventions for patients, families, and health care providers. [Journal of Gerontological Nursing, 44(2), 33-40.].

Engaging the Public to Identify Opportunities to Improve Critical Care: A Qualitative Analysis of an Open Community Forum

Objective

To engage the public to understand how to improve the care of critically ill patients.

Design

A qualitative content analysis of an open community forum (Café Scientifique).

Setting

Public venue in Calgary, Alberta, Canada.

Participants

Members of the general public including patients, families of patients, health care providers, and members of the community at large.

Methods

A panel of researchers, decision-makers, and a family member led a Café Scientifique, an informal dialogue between the populace and experts, over three-hours to engage the public to understand how to improve the care of critically ill patients. Conventional qualitative content analysis was used to analyze the data. The inductive analysis occurred in three phases: coding, categorizing, and developing themes.

Results

Thirty-eight members of the public (former ICU patients, family members of patients, providers, community members) attended. Participants focused the discussion and provided concrete suggestions for improvement around communication (family as surrogate voice, timing of conversations, decision tools) and provider well-being and engagement, as opposed to medical interventions in critical care.

Conclusions

Café participants believe patient and family centered care is important to ensure high-quality care in the ICU. A Café Scientifique is a valuable forum to engage the public to contribute to priority setting areas for research in critical care, as well as a platform to share lived experience. Research stakeholders including health care organizations, governments, and funding organizations should provide more opportunities for the public to engage in meaningful conversations about how to best improve healthcare.

Supporting families of dying patients in the intensive care units

Family support in the intensive care units is a challenge for nurses who take care of dying patients. This article aimed to determine the Iranian nurses' experience of supporting families in end-of-life care. Using grounded theory methodology, 23 critical care nurses were interviewed. The theme of family support was extracted and divided into 5 categories: death with dignity; facilitate visitation; value orientation; preparing; and distress. With implementation of family support approaches, family-centered care plans will be realized in the standard framework.

Dignified Palliative Long-Term Care: An Interpretive Systemic Framework of End-of-Life Integrated Care Pathway for Terminally Ill Chinese Older Adults

PURPOSE

To critically examine the system dynamics necessary for successfully implementing a novel end-of-life integrated care pathway (EoL-ICP) program in promoting dignity and quality of life among terminally-ill Chinese nursing home residents.

METHODS

Thirty stakeholders were recruited to participate in 4 interpretive-systemic focus groups.

RESULTS

Framework analysis revealed 10 themes, organized into 3 categories, namely, (1) Regulatory Empowerment (interdisciplinary teamwork, resource allocation, culture building, collaborative policy making), (2) Family-Centered Care (continuity of care, family care conference, partnership in care), and (3) Collective Compassion (devotion in care, empathic understanding, compassionate actions).

CONCLUSIONS

These findings highlight the importance of organizational structure, social discourse, and shared meaning in the provision of EoL-ICP in Chinese societies, underscoring the significant triangulation between political, cultural, and spiritual contexts embodied in the experience of dignity.

Dignity in the older critically ill adult: the family member's perspective

OBJECTIVES

The purpose of this study was to examine the meaning and relative importance that family members of older patients in the intensive care unit (ICU) ascribed to dignity.

BACKGROUND

Dignity is a core value of the nursing profession and of critical care nursing practice. Although there is a substantial body of research supporting the needs of family members of patients in the ICU, little is known about the needs of family members of older, critically ill patients, particularly as they relate to patient dignity.

METHODS

A qualitative, descriptive approach using unstructured interviews was used. Data consisted of audio taped interviews of study participants. Data were analyzed using the constant comparative method.

RESULTS

Three major themes were identified including: 1) the older patient's health status and ICU experiences; 2) family roles, relationships, and goals; and 3) staff interactions with family members.

CONCLUSION

Insight into the concerns of family members related to the dignity of the older critically ill patient may be useful in guiding nurses as they provide care in what are often fast-paced, highly technical environments. Meeting well established family needs as well as attending to the unique concerns identified in this study will assist nurses in supporting the older, critically ill patient's dignity.