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Abdollahimohammad A, Rahnama M, Firouzkouhi M. Experiences of family members when accompanying patients in intensive care units: A qualitative study. Nurs Crit Care 2024; 29:777-784. [PMID: 38459751 DOI: 10.1111/nicc.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/02/2024] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Family members of Intensive Care Unit (ICU) patients encounter numerous challenges while providing companionship to their hospitalized loved ones. AIM This study aims to explore the experiences of family members with loved ones hospitalized in ICUs. STUDY DESIGN Qualitative research was conducted using a content analysis approach. Ten family members of ICU patients were recruited using purposive sampling. Data were collected through semi-structured, in-depth interviews and analysed following Graneheim and Lundman's suggested steps. FINDINGS Analysis of interviews with ten family members of ICU patients revealed a theme of "challenging companionship on an obscure path," encompassing four categories (1-4) and nine subcategories (a, b and c). These included (1) the interplay between the patient and the family: a. family affected by the patient's condition; b. patient affected by the family's condition; (2) mixed emotions of apprehension and anticipation regarding ICU admission: a. fear of ICU hospitalization; b. hope for ICU hospitalization; (3) unaddressed needs and concerns: a. pressure from the ICU's visiting limitations; b. lack of a resting room to settle; c. vague information about the patient's condition; (4) two-way care suffering for families a. direct suffering associated with companionship; b. indirect suffering while observing the patients' suffering. CONCLUSIONS Families of ICU patients encounter various challenges, revealing the complex interplay of emotions, needs and challenges within the ICU. This highlights the intricate dynamics in this critical health care environment. RELEVANCE TO CLINICAL PRACTICE A holistic and empathetic approach in clinical practice is crucial in ICU care, particularly during the challenging journey patients and their families undergo in this critical setting. Health care systems and providers should adapt ICU rules to address evolving needs, alleviate concerns and enhance the overall family experience during their loved one's hospitalization in the ICU.
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Affiliation(s)
| | - Mozhgan Rahnama
- Department of Nursing, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammadreza Firouzkouhi
- Department of Nursing, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran
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Cypress B, Gharzeddine R, Rosemary Fu M, Ransom M, Villarente F, Pitman C. Healthcare professionals perspective of the facilitators and barriers to family engagement during patient-and-family-centered-care interdisciplinary rounds in intensive care unit: A qualitative exploratory study. Intensive Crit Care Nurs 2024; 82:103636. [PMID: 38301418 DOI: 10.1016/j.iccn.2024.103636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Family engagement in care for critically ill patients remains an inconsistent practice and an understudied area of nursing science. Rounds for this study is an interdisciplinary activity conducted at the bedside in partnership with patients, their families, and the health care professionals involved in providing the care. We sought to explore and describe the facilitators and barriers to family engagement during patient and family-centered interdisciplinary rounds in the intensive care unit. RESEARCH METHODOLOGY/DESIGN This qualitative exploratory study is part of a multisite experimental study (#Pro2020001614; NCT05449990). We analyzed the narrative data from the qualitative questions added in the survey from 52 healthcare professionals involved in a multisite experimental study using Braun and Clarke's (2006) constructionist, contextualist approach to thematic analysis. SETTING The study was conducted in the intensive care unit of two medical centers. MAIN OUTCOME MEASURES The findings presented are themes illuminated from thematic analysis namely communication gaps, family's lack of resources, familial and healthcare providers' characteristics, lack of leadership, interprofessional support, policy, and guidelines. FINDINGS Family engagement in critical care during interdisciplinary rounds occurred within the intersectionality among families, healthcare professionals' practice, and organizational factors. The facilitators for family engagement include supported, championed, and advocated-for family adaptation, teams, and professional practice, and organizational receptivity, and support. Communication and leadership are the precursors to family engagement. CONCLUSIONS The findings added new knowledge for exploring the nature and scope of family engagement in critical care. Family engagement must be incorporated into the organizational vision and mission, and healthcare delivery systems. IMPLICATIONS FOR CLINICAL PRACTICE There is a need to further investigate the resources, organizational support mechanisms, and systems that affect patients, families, and healthcare professionals, and the establishment of policies that will aid in reducing barriers to family engagement in the intensive care unit.
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Debay V, Hallot S, Goldfarb M. Healthcare provider perspectives on family participation in cardiac ICU rounds: Before and after intervention survey. Intensive Crit Care Nurs 2024; 82:103655. [PMID: 38367475 DOI: 10.1016/j.iccn.2024.103655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Vanessa Debay
- McGill Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sophie Hallot
- McGill Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
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Wilk C, Petrinec A. Psychometric Evaluation of the Family Willingness for Caregiving Scale. Am J Crit Care 2024; 33:192-201. [PMID: 38688853 DOI: 10.4037/ajcc2024809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Family members and close friends of patients undergoing mechanical ventilation in the intensive care unit (ICU) often experience stress and a sense of helplessness. Participating in the care of their loved one may improve their adaptation to the ICU environment and better prepare them for caregiving after discharge. OBJECTIVES The primary aim of this study was to develop the Family Willingness for Caregiving Scale (FWCS) and test its psychometric properties. The secondary aim was to examine relationships between family members' demographic characteristics and caregiving willingness. METHODS The process of scale development followed DeVellis's 8-step method, and the scale was tested in 3 phases. The first 2 phases examined content validity and face validity, respectively. In phase 3, the FWCS was administered to a sample of family members currently visiting an ICU patient. RESULTS Content validity and face validity were confirmed. The internal consistency reliability of the scale was acceptable, and exploratory factor analysis revealed a 1-factor structure comprising both physical and emotional/supportive care tasks. Caregiving willingness differed significantly by sex, with women reporting greater willingness than men reported. CONCLUSIONS Further testing of the FWCS is needed. After refinement, the FWCS could be used to evaluate factors contributing to caregiving willingness of family members of ICU patients and advance the science related to family engagement in the ICU. Additionally, it could be used as a practical tool to suggest family caregiving activities in the ICU.
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Affiliation(s)
- Cindy Wilk
- Cindy Wilk is a professor at the Kent State University College of Nursing, Kent, Ohio
| | - Amy Petrinec
- Amy Petrinec is an associate professor at the Kent State University College of Nursing, Kent, Ohio
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Freudiger K, Verweij L, Naef R. Translation and Psychometric Validation of the German Version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ): A Cross-Sectional Study. JOURNAL OF FAMILY NURSING 2024; 30:114-126. [PMID: 38622871 DOI: 10.1177/10748407241234262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Supporting families experiencing critical illness through family interventions is essential to ease illness burden, enable family management, and reduce their risk for adverse health. Thus far, there is no validated German instrument to measure the perceived support families receive from nurses. We translated the 14-item Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and tested its psychometric properties with 77 family members of intensive care patients. Compared with the original instrument, the construct validity of the German ICE-FPSQ (FPSQ-G) showed unstable results with a partially divergent structure, most likely caused by the limited sample size. The first two principal components explained 61% of the overall variance and a good internal consistency with a Cronbach's alpha of .92. The FPSQ-G is a promising instrument to measure family members' perceptions of the support they received from nurses in the acute critical care setting but requires further validation.
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Affiliation(s)
| | - Lotte Verweij
- University of Zurich, Switzerland
- University Hospital Zurich, Switzerland
| | - Rahel Naef
- University of Zurich, Switzerland
- University Hospital Zurich, Switzerland
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Ratliff HC, Yakusheva O, Boltey EM, Marriott DJ, Costa DK. Patterns of interactions among ICU interprofessional teams: A prospective patient-shift-level survey approach. PLoS One 2024; 19:e0298586. [PMID: 38625976 PMCID: PMC11020828 DOI: 10.1371/journal.pone.0298586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/28/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND The Awakening, Breathing Coordination, Delirium monitoring and Early mobility bundle (ABCDE) is associated with lower mortality for intensive care unit (ICU) patients. However, efforts to improve ABCDE are variably successful, possibly due to lack of clarity about who are the team members interacting when caring for each patient, each shift. Lack of patient shift-level information regarding who is interacting with whom limits the ability to tailor interventions to the specific ICU team to improve ABCDE. OBJECTIVE Determine the number and types of individuals (i.e., clinicians and family members) interacting in the care of mechanically ventilated (MV) patients, as reported by the patients' assigned physician, nurse, and respiratory therapist (RT) each shift, using a network science lens. METHODS We conducted a prospective, patient-shift-level survey in 2 medical ICUs. For each patient, we surveyed the assigned physician, nurse, and RT each day and night shift about who they interacted with when providing ABCDE for each patient-shift. We determined the number and types of interactions, reported by physicians, nurses, and RTs and day versus night shift. RESULTS From 1558 surveys from 404 clinicians who cared for 169 patients over 166 shifts (65% response rate), clinicians reported interacting with 2.6 individuals each shift (physicians: 2.65, nurses: 3.33, RTs: 1.86); this was fewer on night shift compared to day shift (1.99 versus 3.02). Most frequent interactions were with the bedside nurse, attending, resident, intern, and RT; family member interactions were reported in less than 1 in 5 surveys (12.2% of physician surveys, 19.7% of nurse surveys, 4.9% of RT surveys). INTERPRETATION Clinicians reported interacting with 3-4 clinicians each shift, and fewer on nights. Nurses interacted with the most clincians and family members. Interventions targeting shift-level teams, focusing on nurses and family members, may be a way to improve ABCDE delivery and ICU teamwork.
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Affiliation(s)
- Hannah C. Ratliff
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Olga Yakusheva
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Emily M. Boltey
- VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - Deanna J. Marriott
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Deena Kelly Costa
- School of Nursing, Yale University, West Haven, CT, United States of America
- Section of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, Yale University, New Haven, CT, United States of America
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Soleimani M, Fakhr‐Movahedi A, Yarahmadi S. Family engagement in the care of infectious patients in intensive care units: A hybrid concept analysis. Nurs Open 2024; 11:e2117. [PMID: 38429918 PMCID: PMC10907824 DOI: 10.1002/nop2.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/06/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
AIM This study aims to define and investigate characteristics, antecedents, and consequences of the concept of family engagement in caring for patients with infectious diseases hospitalised in intensive care units. DESIGN This is a three-phase hybrid model study (theoretical, fieldwork, and analytical phase). METHODS The York University Guidelines were used in the theoretical phase, and ultimately, 16 pieces of literature related to the subject under study from 2011 to 2021 were reviewed. The content analysis was used for fieldwork phases; eight participants were interviewed. Then, the theoretical and fieldwork findings were compared, integrated, and analysed. RESULTS This concept has characteristics such as; awareness, belief, perception, and willingness of the nurse to engage the family; a sense of responsibility, willingness, and sacrifice of the family; the physical or virtual presence of the family; triangular interaction between the nurse, patient, and family; perception and identifying the goals; education and information transfer; team collaboration; delegation of responsibility to the family; decision making; and protection of the family. Antecedents include the availability of infrastructure; patient, family, and nurse conditions; and the quality implementation of engagement. The consequences include positive consequences related to the patient, family, nursing, and society, as well as some negative consequences. This study provided a comprehensive perception of family engagement in the care of patients with infectious diseases in intensive care units and defined it more clearly, showing its characteristics, antecedents, and consequences. PATIENT OR PUBLIC CONTRIBUTION Eight participants were interviewed, including five nurses, two family caregivers, and one patient.
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Affiliation(s)
- Mohsen Soleimani
- Nursing Care Research Center, School of Nursing and MidwiferySemnan University of Medical SciencesSemnanIran
| | - Ali Fakhr‐Movahedi
- Nursing Care Research Center, School of Nursing and MidwiferySemnan University of Medical SciencesSemnanIran
| | - Sajad Yarahmadi
- Social Determinants of Health Research Center, School of Nursing and MidwiferyLorestan University of Medical SciencesKhorramabadIran
- Student Research CommitteeSemnan University of Medical SciencesSemnanIran
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Verweij L, Oesch S, Naef R. Tailored implementation of the FICUS multicomponent family support intervention in adult intensive care units: findings from a mixed methods contextual analysis. BMC Health Serv Res 2023; 23:1339. [PMID: 38041092 PMCID: PMC10693161 DOI: 10.1186/s12913-023-10285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The Family in Intensive Care UnitS (FICUS) trial investigates the clinical effectiveness of a multicomponent, nurse-led interprofessional family support intervention (FSI) and explores its implementation in intensive care units (ICUs). The local context of each ICU strongly influences intervention performance in practice. To promote FSI uptake and to reduce variation in intervention delivery, we aimed to develop tailored implementation strategies. METHODS A mixed method contextual analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed from March to June 2022 on eight ICUs assigned to the intervention group. ICU key clinical partners were asked to complete a questionnaire on CFIR inner setting measures (i.e., organizational culture, resources, learning climate and leadership engagement) and the Organizational Readiness for Implementing Change (ORIC) scale prior to group interviews, which were held to discuss barriers and facilitators to FSI implementation. Descriptive analysis and pragmatic rapid thematic analysis were used. Then, tailored implementation strategies were developed for each ICU. RESULTS In total, 33 key clinical partners returned the questionnaire and 40 attended eight group interviews. Results showed a supportive environment, with CFIR inner setting and ORIC measures each rated above 3 (scale: 1 low-5 high value), with leadership engagement scoring highest (median 4.00, IQR 0.38). Interview data showed that the ICU teams were highly motivated and committed to implementing the FSI. They reported limited resources, new interprofessional information exchange, and role adoption of nurses as challenging. CONCLUSION We found that important pre-conditions for FSI implementation, such as leadership support, a supportive team culture, and a good learning climate were present. Some aspects, such as available resources, interprofessional collaboration and family nurses' role adoption were of concern and needed attention. An initial set of implementation strategies were relevant to all ICUs, but some additions and adaptation to local needs were required. Multi-component interventions are challenging to implement within complex systems, such as ICUs. This pragmatic, theory-guided, mixed methods contextual analysis demonstrated high readiness and commitment to FSI implementation in the context of a clinical trial and enabled the specification of a tailored, multifaceted implementation strategy.
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Affiliation(s)
- Lotte Verweij
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
| | - Saskia Oesch
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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Dijkstra BM, Felten-Barentsz KM, van der Valk MJM, van der Hoeven JG, Schoonhoven L, Vloet LCM. Exploring patients' and relatives' needs and perceptions regarding family participation in essential care in the intensive care unit: A qualitative study. Intensive Crit Care Nurs 2023; 79:103525. [PMID: 37598505 DOI: 10.1016/j.iccn.2023.103525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES To examine the needs, perceptions and influencing factors according to former adult intensive care unit patients and relatives with regard to family participation in essential care in the unit. RESEARCH DESIGN A qualitative interpretive descriptive study using inductive thematic analysis. SETTING Twelve pairs of former Dutch patients and their relatives were interviewed within two months after the patient's discharge from the unit between December 2017 and April 2018. FINDINGS Four themes emerged: the family's history, the patient's condition, supporting the patient and supporting the relative. The family's history, in particular the relationship with the patient and former experience with care, determined the level of participation in essential care. The level of participation was also influenced by the patient's condition, more specifically level of consciousness, stability of the patient's situation and length of the patient's stay. The third theme, supporting the patient, related to presence/being able to 'be there' for the patient and a mostly positive attitude towards family participation. The last theme was supporting the relative, with three subthemes associated with relatives' needs and perceptions: (dis)comfort with participation in essential care, need for invitation and support, and concern about the possible strain experienced by relatives. CONCLUSION Supporting the patient and supporting the relative are reflecting the needs and perceptions of patients and relatives regarding family participation in essential care. Both the family's history and the patient's condition influence the relative's level of participation. Intensive care unit nurses and other healthcare providers could take these themes into account when encouraging family participation in essential care. IMPLICATIONS FOR CLINICAL PRACTICE Patients' and relatives' needs and perceptions of family participation in essential care in the intensive care unit vary. Family participation in essential care is influenced by the family's history and the patient's condition. Healthcare providers could take these findings into account when implementing family participation in essential care.
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Affiliation(s)
- Boukje M Dijkstra
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; Intensive Care Unit, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Karin M Felten-Barentsz
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Margriet J M van der Valk
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands
| | | | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Lilian C M Vloet
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Foundation Family and Patient Centered Intensive Care, Alkmaar, the Netherlands
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Price AM, McAndrew NS, Thaqi Q, Kirk M, Brysiewicz P, Eggenberger S, Naef R. Factors influencing critical care nurses' family engagement practices: An international perspective. Nurs Crit Care 2023; 28:1031-1044. [PMID: 35831205 DOI: 10.1111/nicc.12824] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Family engagement positively impacts patient and family members' experiences of care and health outcomes. While partnering with families denotes best practice in intensive care units (ICUs), its full adoption requires improvement. A better understanding of the factors that influence the implementation of family engagement practices is necessary. AIM To investigate the factors that enable or hinder adult ICU nurse-family engagement and to explore potential international variations. STUDY DESIGN Descriptive, cross-sectional survey. Nurses from 10 countries completed the 'Questionnaire on Factors that Influence Family Engagement' (QFIFE), including five open-ended questions. We performed descriptive statistics on quantitative data and content analysis for open-ended questions, and then integrated the findings according to influencing factors and geographical patterns. This was part of a larger qualitative study where 65 nurses participated from adult intensive care units. RESULTS Sixty-one nurses completed the questionnaire, making a response rate of 94%. Overall, patient acuity (Md = 5.0) and nurses' attitudes (Md = 4.6) seemed to be the most influential facilitator, followed by nurse workflow (Md = 4.0) and ICU environment (Md = 3.1) (score 1-6 most influential). The open-ended question data showed a more nuanced picture of the complexity of family engagement in care around these four determinants. Adding a fifth determinant, namely Families are complex structures that respond uniquely to the ICU and patient, revealed that difficult family dynamics, miscommunication and family having difficulty in understanding the situation or health literacy, hindered family engagement. Exploring geographical variations, Africa/Middle East consistently differed from others on three of the four QFIFE subscales, showing lower median levels. CONCLUSIONS Some determinants are perceived to be more influential than others, becoming barriers or enablers to nurse-family engagement in adult ICU. Research that investigates contextual determinants and which compares implementation and improvement initiatives tailored to address family engagement practices barriers and enablers are needed. RELEVANCE TO CLINICAL PRACTICE Knowledge of this international study expands our understanding of enablers and barriers in family engagement that may inform family engagement practice improvement efforts around the world.
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Affiliation(s)
- Ann M Price
- Faculty of Medicine, Health and Social Care, School of Nursing, Midwifery and Social Work, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Natalie S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Qendresa Thaqi
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zürich, Switzerland
| | - Mary Kirk
- Faculty of Medicine, Health and Social Care, School of Nursing, Midwifery and Social Work, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sandra Eggenberger
- College of Allied Health and Nursing, Glen Taylor Nursing Institute for Family and Society, Minnesota State University, Mankato, Minnesota, USA
| | - Rahel Naef
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zürich, Switzerland
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Mukpradab S, Cussen J, Ranse K, Songwathana P, Marshall AP. Healthcare professionals perspectives on feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients: A descriptive qualitative study. J Clin Nurs 2023; 32:6574-6584. [PMID: 36924051 DOI: 10.1111/jocn.16685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023]
Abstract
AIMS To explore healthcare professionals' perceptions of the feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients. BACKGROUND Early mobilisation is beneficial to minimise intensive care unit acquired-weakness in critically ill patients and family engagement can help with meeting early mobilisation goals, but it is not widely practiced. Understanding healthcare professionals' perceptions of feasibility and acceptability of family engagement in early mobilisation of adult critically ill patients is required to inform future implementation strategies to promote early mobilisation. DESIGN A descriptive qualitative study. METHODS Face-to-face, individual, semi-structured interviews were conducted between August 2021 and March 2022 with healthcare professionals working in two intensive care units in Australia. The interviews were analysed using the inductive content analysis, and descriptive statistics were used to summarise participant characteristics. The COREQ checklist was followed when reporting this study. RESULTS Eleven ICU nurses, five physiotherapists and four physicians participated in the interviews. Three main categories were identified: (i) healthcare professionals' readiness, (ii) mediators of engagement and (iii) foundations for successful implementation. Most participants demonstrated a positive attitude towards an implementation of family engagement in early mobilisation for adult critically ill patients; however, capability and capacity of healthcare professionals, family members' willingness, availability and readiness and the care context were considered factors that could influence the successful implementation. CONCLUSION From the perspectives of healthcare professionals, family engagement in early mobilisation is feasible and acceptable to enact but implementation is influenced by contextual factors including, healthcare professionals' capability and capacity and family members' willingness, availability and readiness. Collaborative teamwork and preparing family members and healthcare professionals are needed to support this practice. RELEVANCE TO CLINICAL PRACTICE The findings provide important information to further identify potential strategies of family engagement in early mobilisation and to help and mitigate factors that impede implementation.
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Affiliation(s)
- Sasithorn Mukpradab
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Julie Cussen
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University Parklands Drive, Southport, Queensland, Australia
| | | | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University Parklands Drive, Southport, Queensland, Australia
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Oesch S, Verweij L, Clack L, Finch T, Riguzzi M, Naef R. Implementation of a multicomponent family support intervention in adult intensive care units: study protocol for an embedded mixed-methods multiple case study (FICUS implementation study). BMJ Open 2023; 13:e074142. [PMID: 37553195 PMCID: PMC10414125 DOI: 10.1136/bmjopen-2023-074142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The implementation of complex interventions is considered challenging, particularly in multi-site clinical trials and dynamic clinical settings. This study protocol is part of the family intensive care units (FICUS) hybrid effectiveness-implementation study. It aims to understand the integration of a multicomponent family support intervention in the real-world context of adult intensive care units (ICUs). Specifically, the study will assess implementation processes and outcomes of the study intervention, including fidelity, and will enable explanation of the clinical effectiveness outcomes of the trial. METHODS AND ANALYSIS This mixed-methods multiple case study is guided by two implementation theories, the Normalisation Process Theory and the Consolidated Framework for Implementation Research. Participants are key clinical partners and healthcare professionals of eight ICUs allocated to the intervention group of the FICUS trial in the German-speaking part of Switzerland. Data will be collected at four timepoints over the 18-month active implementation and delivery phase using qualitative (small group interviews, observation, focus group interviews) and quantitative data collection methods (surveys, logs). Descriptive statistics and parametric and non-parametric tests will be used according to data distribution to analyse within and between cluster differences, similarities and factors associated with fidelity and the level of integration over time. Qualitative data will be analysed using a pragmatic rapid analysis approach and content analysis. ETHICS AND DISSEMINATION Ethics approval was obtained from the Cantonal Ethics Committee of Zurich BASEC ID 2021-02300 (8 February 2022). Study findings will provide insights into implementation and its contribution to intervention outcomes, enabling understanding of the usefulness of applied implementation strategies and highlighting main barriers that need to be addressed for scaling the intervention to other healthcare contexts. Findings will be disseminated in peer-reviewed journals and conferences. PROTOCOL REGISTRATION NUMBER Open science framework (OSF) https://osf.io/8t2ud Registered on 21 December 2022.
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Affiliation(s)
- Saskia Oesch
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Lotte Verweij
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Marco Riguzzi
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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13
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Tsukuda M, Ito Y, Kakazu S, Sakamoto K, Honda J. Development and Validity of the Japanese Version of the Questionnaire on Factors That Influence Family Engagement in Acute Care Settings. NURSING REPORTS 2023; 13:601-611. [PMID: 37092481 PMCID: PMC10123640 DOI: 10.3390/nursrep13020053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/11/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023] Open
Abstract
There exists an international consensus on the importance of family-centered care (FCC) in intensive care settings and the evaluation of collaboration between nurses and families; however, FCC is currently practiced blindly in Japan. In this study, we developed a Japanese version of the questionnaire, Factors that Influence Family Engagement (QFIFE-J) and examined its reliability and validity. A web-based survey was conducted with 250 nurses working in the intensive care unit (ICU). Exploratory and validatory factor analyses were used to ascertain factor validity. Criterion-related validity was tested using correlation analysis with the ICU Nurses’ Family Assistance Practice Scale. Internal consistency and reproducibility were verified for reliability. Following exploratory and confirmatory factor analyses, a 15-item measure emerged comprising four factors: “ICU environment”, “nurses’ attitudes”, “nurses’ workflow”, and “patient acuity”. Confirmatory factor analyses showed a generally good fit. Cronbach’s α for the overall scale was 0.78, indicating acceptable internal consistency. The intraclass coefficient for test–retest reliability was 0.80. It was found that the QFIFE-J was reliable and valid and may help determine the factors that promote or inhibit FCC. Additionally, this study has also clarified the current status and family support related issues in ICUs in Japan.
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Affiliation(s)
- Makoto Tsukuda
- College of Nursing Art and Science, University of Hyogo, 13-71 Kitaoji-cho, Akashi 673-0021, Japan
| | - Yoshiyasu Ito
- College of Nursing Art and Science, University of Hyogo, 13-71 Kitaoji-cho, Akashi 673-0021, Japan
| | - Shota Kakazu
- Graduate School of Nursing Sciences, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
| | - Katsuko Sakamoto
- Nursing Department, Hyogo Prefectural KOBE Children’s Hospital, 1-6-7 Minatojima Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Junko Honda
- College of Nursing Art and Science, University of Hyogo, 13-71 Kitaoji-cho, Akashi 673-0021, Japan
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14
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Dijkstra B, Uit Het Broek L, van der Hoeven J, Schoonhoven L, Bosch F, Van der Steen M, Rood P, Vloet L. Feasibility of a standardized family participation programme in the intensive care unit: A pilot survey study. Nurs Open 2023; 10:3596-3602. [PMID: 36617388 PMCID: PMC10170932 DOI: 10.1002/nop2.1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
AIM To assess the feasibility and applicability of a standardized programme to facilitate family participation in essential care activities in the intensive care unit. DESIGN Pilot study with a cross-sectional survey design. METHODS A standardized programme to facilitate family participation in essential nursing care activities was implemented in intensive care units of three hospitals in the Netherlands from November 2018 until March 2019. The feasibility and applicability of the programme were assessed with surveys of the patients, relatives and healthcare providers. RESULTS Three intensive care units successfully implemented the standardized programme. Three patients, ten relatives and 37 healthcare providers responded to the surveys. Patients appreciated family participation and recognized that their relatives liked to participate. Relatives appreciated being able to do something for the patient (80%) and to participate in essential care activities (60%). The majority of relatives (60%) felt they had sufficient knowledge and skills to participate and did not feel obliged nor uncomfortable. Healthcare providers felt they were trained adequately and motivated to apply family participation; application was perceived as easy, clear and relatively effortless according to the majority. According to 68% of the healthcare providers, most relatives were perceived to be capable of learning to participate in essential care activities. Some healthcare providers felt uncertain about the patient's wishes regarding family participation, with some indicating the behaviours of relatives and patients discouraged them from offering family participation. Use of a standardized programme to facilitate family participation in essential care activities in the intensive care unit seems feasible and applicable as determined by relatives and healthcare providers.
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Affiliation(s)
- Boukje Dijkstra
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.,Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lucia Uit Het Broek
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.,Acute Care Unit, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Frank Bosch
- Department of Intensive Care, Rijnstate, Arnhem, The Netherlands.,Section Acute Internal Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marijke Van der Steen
- Department of Intensive Care, Maasziekenhuis Pantein, Boxmeer, The Netherlands.,Department of Intensive Care, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Paul Rood
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.,Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lilian Vloet
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.,IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Foundation Family and Patient Centered Intensive Care, Alkmaar, The Netherlands
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15
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Pandhal JK, Van Der Wardt V. Exploring perceptions regarding family-based delirium management in the intensive care unit. J Intensive Care Soc 2022; 23:447-452. [PMID: 36751350 PMCID: PMC9679907 DOI: 10.1177/17511437211037928] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Delirium is a common complication in patients treated in the intensive care unit (ICU). Family members can help alleviate patient anxiety and may be able to aid in the management of delirium. This study aimed to explore the perceptions of former ICU patients and their families together, regarding the involvement of family in delirium management. Method Nine audio-recorded, semi-structured interviews took place with former ICU patients together with a family member. Participants were interviewed after their intensive care follow-up clinic appointment in an East Midlands hospital in England. Interviews were transcribed, coded and analysed using thematic analysis. Results Three themes were identified: 'understanding about delirium'; 'influencers of delirium management: family and healthcare professionals' and 'family-based delirium care'. Participants expressed that family have a valuable role to play in the management of delirium in the ICU. However, education and guidance is needed to support the family in how delirium can be managed and the current treatment options available. It is important for ICU staff to gain an understanding of the patient's life and personality to personalise delirium management to the needs of the patient and their family. Conclusion This study found that family presence and knowledge about the patient may be beneficial to delirium management in the ICU. Further research should investigate the effectiveness of the strategies and interventions to understand their influence on delirium management in ICU patients.
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Affiliation(s)
- Jasmin Kaur Pandhal
- Critical care Research, Leicester Royal
Infirmary, Leicester, UK; Rheumatology and Dermatology
Research, Wellhouse Lane, Barnet, UK,Jasmin Kaur Pandhal, Rheumatology and
Dermatology Research, Wellhouse Lane, Barnet EN5 3DJ
| | - Veronika Van Der Wardt
- Department of primary practice, Philipps-Universität.
Karl-von-Frisch-Straße 4, Marburg, Germany; Division of Rehabilitation, Ageing and
Wellbeing, University of
Nottingham, Nottingham, UK
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16
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Relationships among Demographic, Clinical, and Psychological Factors Associated with Family Caregiver Readiness to Participate in Intensive Care Unit Care. Ann Am Thorac Soc 2022; 19:1881-1891. [PMID: 35649201 DOI: 10.1513/annalsats.202106-651oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: There has been a paradigm shift to partner with family caregivers by actively involving them in the direct care of the patient throughout the critical illness trajectory. Before effectively engaging family members in patient care, clinicians must assess characteristics and circumstances that may affect caregiver readiness to assume a caregiving role in the intensive care unit (ICU). Objectives: To determine how demographic, clinical, and psychological factors are related to characteristics of family caregiver readiness to engage in ICU patient care. Methods: A convenience sample of ICU family caregivers of both adult and pediatric patients in the ICU was recruited for this cross-sectional study. Participants completed the following measures: PROMIS-29 (Patient-Reported Outcomes Measurement and Information System); HADS (Hospital Anxiety and Depression Scale); CaSES (Caregiver Self-Efficacy Scale); Prep Scale (Preparedness for Caregiving Scale); Patient Activation Measure for Caregivers; and FCMFHS (Family Caregiver's Motives for Helping Scale). Data were collected via self-report at a single time point while the caregiver was visiting the critically ill patient in the ICU. Data analysis consisted of descriptive statistics and bivariate correlations. Results: Caregivers (N = 127) were primarily White (82.7%), females (77.2%), with a mean age of 51.8 (standard deviation [SD], 15.6). Most were either spouses (37.8%) or parents (32.3%) of the patient in the ICU. Patients were primarily adult (76.4%) with a mean APACHE (Acute Physiology, Age, Chronic Health Evaluation) III of 45.9 (SD, 22.5). There were significant (P < 0.05) negative correlations between depression, anxiety, and fatigue and all subscales of self-efficacy (resilience r = -0.18 to -0.30; self-maintenance r = -0.44 to -0.63; emotional connectivity r = -0.27 to -0.41; instrumental giving r = -0.34 to -0.46). Caregiver depression was negatively correlated with caregiver activation (r = -0.199) and caregiver preparedness (r = -0.300). Social satisfaction was positively correlated (P < 0.05) with caregiving preparedness, motivation, and all subscales of self-efficacy (preparedness r = 0.19; motivation r = 0.24; resilience r = 0.21; self-maintenance r = 0.49; emotional connectivity r = 0.29; instrumental giving r = 0.36). Conclusions: We found that caregiver symptoms of depression, anxiety, and fatigue are inversely related to caregiver preparation, motivation, and self-efficacy. To develop effective interventions for ICU family caregivers, further research is needed to understand the relationship between caregiver well-being, caregiving readiness, and caregiver involvement in patient care.
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17
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Sepúlveda-Hermosilla D, Irarrázabal-Vargas L, Rojas Silva N. Family participation in the care of the critical patient: An exploratory study. ENFERMERIA INTENSIVA 2022; 33:173-184. [PMID: 36347800 DOI: 10.1016/j.enfie.2021.07.003] [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: 10/05/2020] [Accepted: 07/23/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To determine the level of readiness of the healthcare team regarding family participation in the care of the critically ill adult and their relationship with the individual characteristics of the participants in a medical-surgical intensive care unit (ICU) in Santiago de Chile. METHOD A cross-sectional correlational study using a quantitative method and including a focus group to explore the perception of healthcare staff of family participation in the care of the critically ill patient. RESULTS The level of readiness of the healthcare team for family participation in the care of the critically ill patient is medium, at 13.81 out of a total 20. The greater the readiness, the lower the age (r = -0.215; P = 0.019), the higher the rating of previous experience working with families (r = 0.304; P = 0.006), and the higher the perception of being comfortable with different activities in the care of the critical patient (r = 0.495: P < 0.001). The participants also state that the work environment of the unit, the patient's condition, the relatives' characteristics, personal judgement, and the preparedness of relatives affect their readiness. CONCLUSIONS The results contribute towards determining the healthcare team's level of readiness in a setting where the subject of the study has not been implemented. The readiness of the healthcare team is medium, and is related to individual characteristics of the healthcare staff, and to organizational and family aspects. Therefore, strategies are required to address these aspects that might increase readiness.
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Affiliation(s)
| | - L Irarrázabal-Vargas
- Escuela de Enfermería, Facultad de Medicina, Pontificia Universidad Católica de Chile, Registro ORCID, Santiago, Región Metropolitana, Chile.
| | - N Rojas Silva
- Escuela de Enfermería, Facultad de Medicina, Pontificia Universidad Católica de Chile, Registro ORCID, Santiago, Región Metropolitana, Chile
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18
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Zwicky A, Thaqi Q, Hediger H, Naef R. The influence of nurse characteristics on practice skills and attitudes towards working with families in critical care: A regression analysis. Intensive Crit Care Nurs 2022; 72:103261. [PMID: 35672213 DOI: 10.1016/j.iccn.2022.103261] [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: 03/11/2022] [Revised: 05/01/2022] [Accepted: 05/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The study aimed to identify nurse characteristics that influence their self-perceived practice skills in working with families and their attitudes towards engaging families in adult and neonatal intensive care units. RESEARCH METHODOLOGY/DESIGN Secondary data analysis using a descriptive, cross-sectional design. SETTING An online survey was completed by 256 nurses from six adult intensive (73% response rate) and two neonatal intensive and one intermediate care unit (27% response rate) in a Swiss, university affiliated hospital. MAIN OUTCOME MEASURES Nurses' self-perceived practice skills in working with families were assessed with the "Family Nursing Practice Scale". Attitudes towards families were measured with the "Families' Importance in Nursing Care - Nurses' Attitudes Scale". Data were analysed with multiple linear regression models. RESULTS Prior education in family nursing significantly influenced nurses' self-perceived practice skills in working with families. Nurses' clinical speciality had a significant influence on their attitudes towards overall, and on the subscale "family as a burden". Neonatal intensive care nurses showed more open attitudes towards families overall, but perceived family more often as a burden than nurses in adult intensive care. Nurses' perceived skills and attitudes in family engagement significantly influenced each other. CONCLUSION The results suggest that nurses' prior education in family nursing and clinical speciality determine their ability to work with and engage families in critical care. Our study suggests that integration of family nursing engagement practices in critical care requires educational implementation strategies combined with culture change efforts.
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Affiliation(s)
- Anja Zwicky
- Cantonal Hospital Winterthur, Department of Medicine, Brauerstrasse 15, 8400 Winterthur, Switzerland.
| | - Qendresa Thaqi
- 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, Universitaetstrasse 84, 8006 Zurich, Switzerland.
| | - Hannele Hediger
- Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland.
| | - 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, Universitaetstrasse 84, 8006 Zurich, Switzerland.
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19
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Mailhot T, Cossette S, Lavoie P, Maheu‐Cadotte M, Fontaine G, Bourbonnais A, Côté J. The development of the MENTOR_D nursing intervention: Supporting family involvement in delirium management. Int J Older People Nurs 2022; 17:e12462. [DOI: 10.1111/opn.12462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Tanya Mailhot
- Faculté des Sciences Infirmières Université de Montréal Montréal QC Canada
- Research Centre of the Institut de Cardiologie de Montréal Montréal QC Canada
| | - Sylvie Cossette
- Faculté des Sciences Infirmières Université de Montréal Montréal QC Canada
- Research Centre of the Institut de Cardiologie de Montréal Montréal QC Canada
| | - Patrick Lavoie
- Faculté des Sciences Infirmières Université de Montréal Montréal QC Canada
- Research Centre of the Institut de Cardiologie de Montréal Montréal QC Canada
- Centre d’innovation en Formation Infirmière Université de Montréal Montréal QC Canada
| | - Marc‐André Maheu‐Cadotte
- Faculté des Sciences Infirmières Université de Montréal Montréal QC Canada
- Research Centre of the Institut de Cardiologie de Montréal Montréal QC Canada
- Research Centre of the Centre Hospitalier de l’Université de Montréal Montréal QC Canada
| | - Guillaume Fontaine
- Faculté des Sciences Infirmières Université de Montréal Montréal QC Canada
- Research Centre of the Institut de Cardiologie de Montréal Montréal QC Canada
| | - Anne Bourbonnais
- Faculté des Sciences Infirmières Université de Montréal Montréal QC Canada
- Research Centre of the Institut Universitaire de Gériatrie de Montréal Montréal QC Canada
| | - José Côté
- Faculté des Sciences Infirmières Université de Montréal Montréal QC Canada
- Research Centre of the Centre Hospitalier de l’Université de Montréal Montréal QC Canada
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20
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Unjai S, Forster EM, Mitchell AE, Creedy DK. Compassion satisfaction, resilience and passion for work among nurses and physicians working in intensive care units: A mixed method systematic review. Intensive Crit Care Nurs 2022; 71:103248. [PMID: 35396100 DOI: 10.1016/j.iccn.2022.103248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify, appraise, and synthesise current evidence on prevalence, correlates, and interventions to enhance compassion satisfaction, resilience, and passion for work among nurses and physicians working in intensive care units. METHODS A mixed methods systematic review was conducted. The comprehensive search used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven databases (MEDLINE, EMBASE, CINAHL, JBI, ProQuest, PsycINFO, and Cochrane Library) were searched for literature published between January 2011 and June 2021. The Mixed Methods Appraisal Tool was used to assess methodological quality. Data from included studies were analysed using a convergent mixed methods design. The protocol was prospectively registered (PROSPERO 2021 CRD42021252051). RESULTS A total of 37 studies met the inclusion criteria. Most studies reported moderate levels of compassion satisfaction among intensive care health professionals, whereas levels of resilience varied. Compassion satisfaction and resilience were positively correlated, but relationships between compassion satisfaction and resilience and other correlates (personal factors, psychological factors, and work-related factors) were inconsistently reported. Only four interventions aimed to improve compassion satisfaction or resilience among intensive care health professionals. None of the included studies investigated passion for work. CONCLUSION Compassion satisfaction, resilience, and passion for work among staff in the intensive care unit are important in the current global COVID-19 pandemic. Health professionals report a moderate level of compassion satisfaction but findings in relation to resilience are mixed. No studies examined passion for work. Further research to determine ongoing psychological wellbeing and professional quality of life and evaluate tailored interventions to support intensive care staff well-being is recommended.
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Affiliation(s)
- Supan Unjai
- School of Nursing and Midwifery, Griffith University, Australia.
| | | | - Amy E Mitchell
- School of Nursing and Midwifery, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; Parenting and Family Support Centre, School of Psychology, The University of Queensland, Australia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, Australia
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21
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Dijkstra BM, Felten-Barentsz KM, van der Valk MJM, Pelgrim T, van der Hoeven HG, Schoonhoven L, Ebben RHA, Vloet LCM. Family participation in essential care activities: Needs, perceptions, preferences, and capacities of intensive care unit patients, relatives, and healthcare providers—An integrative review. Aust Crit Care 2022; 36:401-419. [PMID: 35370060 DOI: 10.1016/j.aucc.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Family participation in essential care activities may benefit both patients and relatives. OBJECTIVES In this integrative review, we aimed to identify needs, perceptions, preferences, and capacities regarding family participation in essential care in intensive care units (ICUs) from the patient's, relatives', and ICU healthcare providers' perspective. REVIEW METHOD USED An integrative review method was used. DATA SOURCES PubMed, CINAHL, EMBASE, MEDLINE, Cochrane, Web of Science, and reference lists of included articles were searched, from inception to January 25, 2021. REVIEW METHODS We included studies on family participation in essential care activities during ICU stay which reported associated needs, perceptions, preferences and capacities. Quality assessment was performed with the Kmet Standard Quality Assessment Criteria developed for evaluating primary research papers in a variety of fields, and an extensive qualitative thematic analysis was performed on the results. RESULTS Twenty-seven studies were included. Quality scores varied from 0.45 to 0.95 (range: 0-1). Patients' needs, perceptions, preferences, and capacities are largely unknown. Identified themes on needs and perceptions were relatives' desire to help the patient, a mostly positive attitude among all involved, stress regarding patient safety, perceived beneficial effects, relatives feeling in control-ICU healthcare providers' concerns about loss of control. Preferences for potential essential care activities vary. Relatives want an invitation and support from ICU healthcare providers. Themes regarding capacities were knowledge, skills, education and training, and organisational conditions. CONCLUSIONS Implementation of family participation in essential care requires education and training of relatives and ICU healthcare providers to address safety and quality of care concerns, though most studies lack further specification.
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Affiliation(s)
- Boukje M Dijkstra
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands; Intensive Care Unit, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Karin M Felten-Barentsz
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands; Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Margriet J M van der Valk
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Thomas Pelgrim
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | | | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Remco H A Ebben
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Lilian C M Vloet
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands; IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Foundation Family and Patient Centered Intensive Care, Alkmaar, the Netherlands
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22
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Boltey EM, Wright N, Mosley EA, White MR, Iwashyna TJ, Manojlovich M, Costa DK. Exploring the process of information sharing in an adult intensive care unit: an ethnographic study. J Interprof Care 2022; 36:168-176. [PMID: 33906566 PMCID: PMC8548388 DOI: 10.1080/13561820.2021.1899147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Information sharing, a component of patient and family engagement (PFE), is an important process that may contribute to intensive care unit (ICU) quality of care. Yet, virtually no studies explore how the process of information sharing unfolds in the ICU from the interprofessional team and family member perspectives. To better understand the process of information sharing, we conducted ethnographic fieldwork in a 20-bed medical ICU, focusing on behaviors and interactions of the interprofessional team and family members (May 2016 - October 2016). We completed 17.5 observation hours, 6 shadowing sessions, and 12 semi-structured interviews with 17 total participants. We used thematic content analysis and iterative inductive coding to identify three themes about the information sharing process: 1) family factors (health literacy and past experience with the ICU environment) influence information sharing; 2) clinicians strategies can support engagement in the process of information sharing (assessing families' need for information, understanding a families' hope, using rounds as an opportunity for information sharing); 3) the process of information sharing allows for trust building between families and the ICU team. Our findings suggest that information sharing is a crucial process that may serve as a catalyst for effective patient and family engagement in the ICU.
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Affiliation(s)
| | - Nathan Wright
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor Michigan
| | | | | | - Theodore J. Iwashyna
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor MI,VA Ann Arbor, Center for Clinical Management Research, Ann Arbor MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor MI
| | - Milisa Manojlovich
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor MI
| | - Deena Kelly Costa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor MI
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23
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Hetland BD, McAndrew NS, Kupzyk KA, Krutsinger DC, Pozehl BJ, Heusinkvelt JM, Camenzind CE. Family Caregiver Preferences and Contributions Related to Patient Care in the ICU. West J Nurs Res 2021; 44:214-226. [PMID: 34904483 DOI: 10.1177/01939459211062954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Guided by Individual and Family Self-Management Theory, the purpose of this cross-sectional study was to describe patient care activities that family caregivers endorsed and performed while visiting their family member in the ICU. We found that caregivers wanted to be involved in ICU patient care and had preferences for the care they wanted to perform with their critically ill family member. More than 80% preferred to perform tasks related to daily grooming, communication, and education. Of note, many caregivers expressed interest in holistic healing activities (i.e., music and art), and yet, less than 50% of caregivers reported participating in these activities. The discrepancy between the number of care activities that respondents desired to perform compared to the number of care activities they reported performing represents an important opportunity to shift research and practice improvement efforts toward more tailored family engagement interventions and recognition of family caregivers as essential partners in care.
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Affiliation(s)
- Breanna D Hetland
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA.,Critical Care Division, Nebraska Medicine, Omaha, NE, USA
| | - Natalie S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.,Froedtert Hospital, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dustin C Krutsinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bunny J Pozehl
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
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Sepúlveda-Hermosilla D, Irarrázabal-Vargas L, Rojas Silva N. Participación de la familia en el cuidado del paciente crítico: un estudio exploratorio. ENFERMERIA INTENSIVA 2021. [DOI: 10.1016/j.enfi.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mason TM, Reich RR, Musgrove R, Whiting J, Fusilero J. Nurse Attitudes: A Descriptive Study of Families' Importance in Inpatient Nursing Care. Clin J Oncol Nurs 2021; 25:563-570. [PMID: 34533519 DOI: 10.1188/21.cjon.563-570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Family support and patient outcomes are linked to nurses' attitudes toward families' importance in patient care. OBJECTIVES The purpose of this study was to characterize inpatient oncology nurses' attitudes toward families' importance in nursing care and determine characteristics related to these attitudes. METHODS A descriptive, cross-sectional design was used with a single set of measurements from inpatient oncology nurses at a comprehensive cancer center in the southeastern United States. Nurse characteristics were summarized using frequency and percentages. Time variables were summarized using median and interquartile range. There were five primary outcomes. FINDINGS Nurses considered the role of the family important, but level varied by FINC-NA item. Characteristics related to family importance overall included hospital unit and general approach to care.
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Affiliation(s)
- Tina M Mason
- H. Lee Moffit Cancer Center and Research Institute
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Alexanian J, Fraser I, Smith O, Kitto S. Defining and Redefining Family Involvement in Practice: An Implementation Trial of a Locally Adaptable Patient-Centered Professional Development Tool in Two Ontario Intensive Care Units. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2021; 41:253-262. [PMID: 34799516 DOI: 10.1097/ceh.0000000000000402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Research on best practices for family member involvement has shown that such involvement improves care quality in critical care settings and helps to reduce medical errors leading to adverse events. Although many critical care units promote the principle of "patient-centered care" and family member involvement, there can be a significant gap between knowledge about these processes and their translation into practice. This article is based on an implementation trial of a patient and family involvement knowledge-based tool that involves an educational component for frontline health care workers. By combining ethnographic observation, semistructured interviews, focus groups, and document analysis, we were able to not only examine health care provider views on family involvement but also explore the areas of tension that arose in practice because the introduction of the family involvement tool exposed local factors that shaped the conditions of possibility of family involvement. In particular, unspoken preferences, assumptions, and concerns about family involvement were brought to the fore because this intervention disrupted well-entrenched power dynamics related to family involvement and professional boundaries. Through this ethnographic research, we found that the concept of patient-centered care is not uncontroversial among health care providers and that the form of its practice was largely up for individual interpretation. Interventions and policies that aim to promote patient-centered and family-centered care would benefit from addressing the ways in which these ideas affect the work of different health care professionals and incorporating nursing concerns around family involvement.
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Affiliation(s)
- Janet Alexanian
- Dr. Alexanian: Senior Research Associate, St Michael's Hospital. Dr. Fraser: Chief of Staff, Michael Garron Hospital, and Lecturer, Division of Respirology, Faculty of Medicine, University of Toronto, Toronto, Canada. Dr. Smith: Senior Clinical Program Director, ED and Medicine, Unity Health Toronto, St. Michael's Hospital. Dr. Kitto: Professor, Department of Innovation in Medical Innovation and the Director of Research, Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ontario, Canada
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Ventura Expósito L, Arreciado Marañón A. Needs and participation strategies proposed by the family in the daily care of the critically ill patient. ENFERMERÍA CLÍNICA (ENGLISH EDITION) 2021; 31:294-302. [PMID: 34565501 DOI: 10.1016/j.enfcle.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The continuous and technical assistance that the critical patient requires sometimes produces a barrier with the family, generating the alteration of their needs. Family involvement is beneficial to both the family and the patient. OBJECTIVE I) Knowing the feelings and needs of the patients' relative admitted to an ICU of a third level hospital in Catalonia and II) to study the participation strategies proposed by the relatives. METHODS Phenomenological qualitative study. The sample population selected was the patients' relatives admitted to an UCI of a 3rd level Catalan hospital from May 2017 to February 2018. The sampling was intentional, considering different typologies to guarantee the diversity of the discourse. Semi-structured interviews were conducted, analyzed thematically. The rigor criteria of Guba and Lincoln were applied. RESULTS 15 relatives were interviewed. The participants express negative, positive and transformative feelings. Psychological assistance, having more information and collaborating in the care of your family member are some of the expressed needs. Among the strategies proposed in the absence of care participation is the increase in family hours in the ICU and the support of a nurse educator care. CONCLUSIONS It is necessary to reorient the personnel practice incorporating strategies that further integrate the family in the daily care of the critically ill patient. Helping the family, prioritizing their needs and guiding them in learning is basic and part of the professional care.
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Affiliation(s)
| | - Antonia Arreciado Marañón
- Departamento de Enfermería, Facultad de Medicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain; Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), Spain
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Thirsk LM, Vandall-Walker V, Rasiah J, Keyko K. A Taxonomy of Supports and Barriers to Family-Centered Adult Critical Care: A Qualitative Descriptive Study. JOURNAL OF FAMILY NURSING 2021; 27:199-211. [PMID: 33769127 PMCID: PMC8361475 DOI: 10.1177/1074840721999372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family-centered care (FCC) improves the quality and safety of health care provision, reduces cost, and improves patient, family, and provider satisfaction. Despite several decades of advocacy, research, and evidence, there are still challenges in uptake and adoption of FCC practices in adult critical care. The objective of this study was to understand the supports and barriers to family-centered adult critical care (FcACC). A qualitative descriptive design was used to develop a taxonomy. Interviews and focus groups were conducted with 21 participants in Alberta, Canada, from 2013 to 2014. Analysis revealed two main domains of supports and barriers to FcACC: PEOPLE and STRUCTURES. These domains were further classified into concepts and subconcepts that captured all the reported data. Many factors at individual, group, and organizational levels influenced the enactment of FcACC. These included health care provider beliefs, influence of primary versus secondary tasks, perceptions of family work, nurses' emotional labor, and organizational culture.
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Affiliation(s)
| | | | | | - Kacey Keyko
- Edmonton Southside Primary Care
Network, Alberta, Canada
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Naef R, Brysiewicz P, Mc Andrew NS, Beierwaltes P, Chiang V, Clisbee D, de Beer J, Honda J, Kakazu S, Nagl-Cupal M, Price AM, Richardson S, Richardson A, Tehan T, Towell-Barnard A, Eggenberger S. Intensive care nurse-family engagement from a global perspective: A qualitative multi-site exploration. Intensive Crit Care Nurs 2021; 66:103081. [PMID: 34116886 DOI: 10.1016/j.iccn.2021.103081] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Critical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. OBJECTIVES To describe nurses' perceptions and practices of family engagement in adult intensive care units from a global perspective. DESIGN A qualitative-descriptive multi-site design using content analysis. SETTINGS The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. PARTICIPANTS A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. METHODS Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. RESULTS We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses' practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses' attitudes and perceptions of family, the patient's condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses' ability to engage with families. CONCLUSIONS This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care.
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Affiliation(s)
- Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitätstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, King George Mazisi Kunene Road, Glenwood, Durban 4041, South Africa.
| | - Natalie S Mc Andrew
- College of Nursing, University of Wisconsin-Milwaukee, Cunningham Hall, 1921 East Hartford Avenue, P.O. Box 413, Milwaukee, WI 53201-0413, USA; Froedtert & the Medical College of Wisconsin, Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | - Patricia Beierwaltes
- College of Allied Health and Nursing, School of Nursing, Minnesota State University, 360 Wissink Hall, Mankato, MN 56001, USA.
| | - Vico Chiang
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong.
| | - David Clisbee
- College of Science, Engineering and Technology, Computer Information Science Department, Minnesota State University, 273 Wissink Hall, Mankato, MN 56001, USA.
| | - Jennifer de Beer
- College of Nursing-Jeddah, King Saud bin Abdul Aziz University for Health Sciences-Jeddah, Makkah Highway, Al Haramain Road, Mail Code 65 65, PO Box 9515, Saudi Arabia.
| | - Junko Honda
- Child Health Nursing, College of Nursing Art and Science, University of Hyogo, 13-71, Kitaoji-cho, Akashi, Hyogo 673-8588, Japan.
| | - Shota Kakazu
- Child Health Nursing, Graduate School of Nursing Sciences, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan.
| | - Martin Nagl-Cupal
- Department of Nursing Science, University of Vienna, Alser Strasse 23/12, 1080 Vienna, Austria.
| | - Ann M Price
- School of Nursing, Midwifery and Social Work, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU, United Kingdom.
| | - Sandra Richardson
- School of Health Sciences, College of Education, Health and Human Development, University of Canterbury, 276 Antigua Street, Christchurch 8011, New Zealand; Emergency Department, Christchurch Hospital, Canterbury District Health Board, 2 Riccarton Avenue, Christchurch 8011, New Zealand.
| | - Anna Richardson
- Bachelor of Nursing Programme, Department of Health Practice, Manawa, Ara Institute of Canterbury Ltd, 276 Antigua Street, Christchurch 8140, New Zealand.
| | - Tara Tehan
- University of Massachusetts Medical School, Graduate School of Nursing, 55 Lake Ave North, Worcester, MA 01655, USA.
| | - Amanda Towell-Barnard
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Western Australia 6027, Australia; Sir Charles Gairdner Hospital, Centre for Nursing Research, Hospital Avenue, Nedlands, Western Australia 6009, Australia.
| | - Sandra Eggenberger
- College of Allied Health and Nursing, Glen Taylor Nursing Institute for Family and Society, Minnesota State University, 360 Wissink Hall and 351 7700 France, Mankato, MN 56001, USA.
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BAYKAL D, ÇAVUŞOĞLU A, ÖZTÜRK ERDEN S. Hasta Ailesinin, Nöroloji Yoğun Bakım Hemşireleriyle İletişiminin Araştırılması. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.38079/igusabder.870481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Reppas-Rindlisbacher C, Siddhpuria S, Wong EKC, Lee JY, Gabor C, Curkovic A, Khalili Y, Mavrak C, De Freitas S, Eshak K, Patterson C. Implementation of a multicomponent intervention sign to reduce delirium in orthopaedic inpatients (MIND-ORIENT): a quality improvement project. BMJ Open Qual 2021; 10:bmjoq-2020-001186. [PMID: 33526446 PMCID: PMC7853031 DOI: 10.1136/bmjoq-2020-001186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 11/11/2022] Open
Abstract
Delirium is a serious and common condition that leads to significant adverse health outcomes for hospitalised older adults. It occurs in 30%–55% of patients with hip fractures and is one of the most common postoperative complications in older adults undergoing orthopaedic surgery. Multicomponent, non-pharmacological interventions can reduce delirium incidence by up to 30% but are often challenging to implement as part of routine care. We identified a gap in the delivery of non-pharmacological interventions on an orthopaedic unit. This project aimed to implement a bedside sign on an orthopaedic unit to reduce the occurrence of delirium by prompting staff to use multicomponent evidence-based delirium prevention strategies for at-risk older adults. Quality improvement methods were used to integrate and optimise the use of a bedside ‘delirium prevention’ sign on an orthopaedic unit. The sign was implemented in four target rooms and sign completion rates increased from 47% to 83% (95% CI 71.7% to 94.9%; p<0.001) over a 10-month period. The sign did not have a significant impact on delirium prevalence. The mean Confusion Assessment Method (CAM)+ rate during the baseline period was 8% with an absolute increase in the intervention period to 11.4% (95% CI 7.2% to 15.8%; p=0.31). There were no significant shifts or trends in the run chart for the proportion of patients with CAM+ scores over time. The sign was well received by staff, who reported it was a worthwhile use of time and prompted use of non-pharmacological interventions. This quality improvement project successfully integrated a novel, low-cost, feasible and evidence-based approach into routine clinical care to support staff to deliver non-pharmacological interventions. Given the increased pressures on front-line staff in hospital, tools that reduce cognitive load at the bedside are important to consider when caring for a vulnerable older adult patient population.
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Affiliation(s)
| | - Shailee Siddhpuria
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Kai-Chung Wong
- Division of Geriatric Medicine, University of Toronto Department of Medicine, Toronto, Ontario, Canada.,Geriatric Education and Research in Aging Science (GERAS) Centre, McMaster University, Hamilton, Ontario, Canada
| | - Justin Yusen Lee
- Geriatric Education and Research in Aging Science (GERAS) Centre, McMaster University, Hamilton, Ontario, Canada.,Division of Geriatric Medicine, McMaster University Department of Medicine, Hamilton, Ontario, Canada.,Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | | | | | - Sandra De Freitas
- Hamilton Health Sciences, Hamilton, Ontario, Canada.,Joseph Brant Memorial Hospital, Burlington, Ontario, Canada
| | - Kristeen Eshak
- Division of Geriatric Medicine, McMaster University Department of Medicine, Hamilton, Ontario, Canada
| | - Christopher Patterson
- Geriatric Education and Research in Aging Science (GERAS) Centre, McMaster University, Hamilton, Ontario, Canada .,Division of Geriatric Medicine, McMaster University Department of Medicine, Hamilton, Ontario, Canada.,Hamilton Health Sciences, Hamilton, Ontario, Canada
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Ventura Expósito L, Arreciado Marañón A. Needs and participation strategies proposed by the family in the daily care of the critically ill patient. ENFERMERIA CLINICA 2020; 31:S1130-8621(20)30530-1. [PMID: 33309510 DOI: 10.1016/j.enfcli.2020.10.029] [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: 05/28/2020] [Revised: 09/05/2020] [Accepted: 10/27/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The continuous and technical assistance that the critical patient requires sometimes produces a barrier with the family, generating the alteration of their needs. Family involvement is beneficial to both the family and the patient. OBJECTIVE 1) Knowing the feelings and needs of the patients' relative admitted to an ICU of a third level hospital in Catalonia and 2) To study the participation strategies proposed by the relatives. METHODS Phenomenological qualitative study. The sample population selected was the patients' relatives admitted to an UCI of a 3rd level Catalan hospital from May 2017 to February 2018. The sampling was intentional, considering different typologies to guarantee the diversity of the discourse. Semi-structured interviews were conducted, analyzed thematically. The rigor criteria of Guba and Lincoln were applied. RESULTS 15 relatives were interviewed. The participants express negative, positive and transformative feelings. Psychological assistance, having more information and collaborating in the care of your family member are some of the expressed needs. Among the strategies proposed in the absence of care participation is the increase in family hours in the ICU and the support of a nurse educator care. CONCLUSIONS It is necessary to reorient the personnel practice incorporating strategies that further integrate the family in the daily care of the critically ill patient. Helping the family, prioritizing their needs and guiding them in learning is basic and part of the professional care.
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Affiliation(s)
| | - Antonia Arreciado Marañón
- Departamento de Enfermería, Facultad de Medicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España; Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), España
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McAndrew NS, Mark L, Butler M. Timely Family Feedback to Guide Family Engagement in the Intensive Care Unit. Crit Care Nurse 2020; 40:42-51. [PMID: 33257964 DOI: 10.4037/ccn2020644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Organizations motivated to provide high-quality care in the intensive care unit are exploring strategies to engage families in patient care. Such initiatives are based on emerging evidence that family engagement improves quality and safety of care. OBJECTIVE To gather family feedback to guide future nurse-led quality improvement efforts to engage families in the intensive care unit setting. METHODS The Critical Care Family Satisfaction Survey, which consists of 20 items rated from 1 (very dissatisfied) to 5 (very satisfied), was paired with open-ended questions and administered to families during the intensive care unit stay from March through December 2017. Content analysis was used to identify themes regarding the family experience. RESULTS Responses were collected from 178 family members. The mean (SD) score on the survey was 4.65 (0.33). Five themes emerged regarding the delivery of family care in the intensive care unit: family interactions with the interdisciplinary team, information sharing and effective communication, family navigation of the intensive care unit environment, family engagement in the intensive care unit, and quality of patient care. CONCLUSIONS This quality improvement project provided foundational information to guide family engagement efforts in the intensive care unit. Real-time solicitation of feedback is essential to improving the family experience and guiding family-centered care delivery in this practice environment.
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Affiliation(s)
- Natalie S McAndrew
- Natalie S. McAndrew is an assistant professor, College of Nursing, University of Wisconsin-Milwaukee, and a nurse-scientist, Froedtert Hospital, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Mark
- Laura Mark is a physician assistant in the cardiovascular intensive care unit, Froedtert Hospital, Froedtert & Medical College of Wisconsin
| | - Mary Butler
- Mary Butler is an assistant clinical professor, College of Nursing, University of Wisconsin-Milwaukee
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van Delft LMM, Valkenet K, Slooter AJC, Veenhof C. Family participation in physiotherapy-related tasks of critically ill patients: A mixed methods systematic review. J Crit Care 2020; 62:49-57. [PMID: 33260011 DOI: 10.1016/j.jcrc.2020.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Providing an overview of studies on family participation in physiotherapy-related tasks of critically ill patients, addressing two research questions (RQ): 1) What are the perceptions of patients, relatives, and staff about family participation in physiotherapy-related tasks? and 2) What are the effects of interventions of family participation in physiotherapy-related tasks? MATERIAL AND METHODS Qualitative, quantitative and mixed-methods articles were identified using PubMed, Embase and CINAHL. Studies reporting on family participation in physiotherapy-related tasks of adult critically ill patients were included. A convergent segregated approach for mixed-methods reviews was used. RESULTS Eighteen articles were included; 13 for RQ1, and 5 for RQ2. The included studies were quantitative, qualitative and mixed-method, including between 8 and 452 participants. The descriptive studies exhibit a general appreciation for involvement of relatives in physiotherapy-related tasks, although most of the studies reported on family involvement in general care and incorporated diverse physiotherapy-related tasks. One study explored the effectiveness of family participation on a rehabilitation outcome and showed that the percentage of patients mobilizing three times a day increased. CONCLUSION Positive attitudes were observed among patients, their relatives and staff towards family participation in physiotherapy-related tasks of critically ill patients. However, limited research has been done into the effect of interventions containing family participation in physiotherapy-related tasks.
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Affiliation(s)
- L M M van Delft
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | - K Valkenet
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - A J C Slooter
- Department of Intensive Care Medicine, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - C Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, the Netherlands
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McLennan M, Aggar C. Family satisfaction with care in the intensive care unit: A regional Australian perspective. Aust Crit Care 2020; 33:518-525. [DOI: 10.1016/j.aucc.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/16/2022] Open
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36
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Naef R, Schmid-Mohler G, Ernst J. Psychometric evaluation of the German version of the instrument: Families' Importance in Nursing Care - Nurses' Attitudes (FINC-NA). Scand J Caring Sci 2020; 35:328-339. [PMID: 33128295 DOI: 10.1111/scs.12924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The involvement of families in care has long been advocated for acute and critical care settings to improve quality and safety of care. Nurses' attitudes towards families influence the way they involve and partner with families in the planning and delivery of care. Therefore, instruments with proven psychometric properties are necessary to assess the attitudes of nurses towards involving families in nursing care. AIMS To cross-culturally adapt and psychometrically test the German version of the Families' Importance in Nursing Care - Nurses' Attitudes (FINC-NA) scale with acute and critical care nurses. METHODS A cross-sectional study was carried out with 316 acute-critical care nurses, who filled in the FINC-NA between December 2016 and May 2018. Exploratory factor analysis was performed to assess structural validity. Internal consistency and homogeneity were determined using Cronbach's alpha. RESULTS The four-factor structure of the FINC-NA - family as partner in care, family as resource in nursing care, family as their own resource and family as burden - was confirmed in the German version. Due to low primary and multiple loadings, seven items were removed. Moreover, five items loaded on different factors than the original version. Cronbach's alpha of factors ranged between 0.68 and 0.86. CONCLUSION The cross-cultural adaptation and psychometric testing of the German version of the FINC-NA resulted in a 19-item scale that measure nurses' attitudes towards the importance of families in nursing care. Further testing is needed to refine the structural validity and establish construct validity of the FINC-NA German version.
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Affiliation(s)
- Rahel Naef
- Center of Clinical Nursing Science, University Hospital Zurich, Switzerland.,Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Jutta Ernst
- Center of Clinical Nursing Science, University Hospital Zurich, Switzerland
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Jafarpoor H, Vasli P, Manoochehri H. How is family involved in clinical care and decision-making in intensive care units? A qualitative study. Contemp Nurse 2020; 56:215-229. [PMID: 32715979 DOI: 10.1080/10376178.2020.1801350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Involving family members in patient care is considered as a significant dimension of family-centered care in intensive care units (ICUs). Aims: To describe family members' perceptions and experiences regarding involvement in clinical care delivery and decision-making in ICUs in Iran. Design: A qualitative research method using conventional content analysis. Methods: A total number of 24 participants were selected through purposive sampling method between 2018 and 2019. Each interview also lasted between 30 and 60 min and the inductive data analysis was used. Results: The findings revealed that non-agreed involvement in clinical care delivery and family involvement in decision-making is being implemented on a continuum of paternalistic views. Conclusion: Healthcare providers, particularly nurses, and policy makers can thus exploit these findings to strengthen family involvement in this regard and consequently improve quality of care. Impact statement: A non-agreed approach and paternalistic views along with some barriers can affect family members' involvement in providing clinical care and making decisions in ICUs in Iran.
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Affiliation(s)
- Hasanali Jafarpoor
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Vasli
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Houman Manoochehri
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Naef R, Massarotto P, Petry H. Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study. Intensive Crit Care Nurs 2020; 61:102916. [PMID: 32807604 DOI: 10.1016/j.iccn.2020.102916] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate family and health professional experience with a nurse-led family support intervention in intensive care. DESIGN Qualitative evaluation study. SETTING A twelve-bed surgical intensive care unit in a 900-bed University Hospital in Switzerland. MAIN OUTCOME MEASURES Data were collected through 16 semi-structured interviews with families (n = 19 family members) and three focus group interviews with critical care staff (n = 19) and analysed using content analysis strategies. FINDINGS Four themes related to the new family support intervention were identified. First, families and staff described it as a valuable and essential part of ICU care. Second, it facilitated staff-family interaction and communication. Third, from staff perspective, it promoted the quality of family care. Fourth, staff believed that the family support intervention enabled them to better care for families through increased capacity for developing and sustaining relationships with families. CONCLUSIONS An advanced practice family nursing role coupled with a family support pathway is an acceptable, appreciated and beneficial model of care delivery in the inttensive care unit from the perspective of families and critical care staff. Further research is needed to investigate the intervention's effectiveness in the intensive care unit.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland; Institute of Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Switzerland.
| | - Paola Massarotto
- Institute of Intensive Medicine, University Hospital Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland
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Seyedfatemi N, Mohammadi N, Hashemi S. Promoting patients health in intensive care units by family members and nurses: A literature review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:114. [PMID: 32642470 PMCID: PMC7325791 DOI: 10.4103/jehp.jehp_506_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/23/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hospitalization in intensive care units (ICUs) can cause physiological and psychological challenges for patients and their family members. Using a family-centered approach in provision of visiting hours promotes the health of patients. The purpose of this study is to review the perception of nurses and family members of patients in ICUs about visiting their patients. METHODOLOGY The published articles in the last 10 years from 2008 to 2018 on the perception of nurses and family members of patients in critical care units about visiting their patients searched for in databases including ScienceDirect, PubMed, Cochrane, Google Scholar, SID, Scopus, CINAHL, OVID, IRANDOC, and Magiran using keywords "family members perception," "nurses' perception," "intensive care units," and "visiting" in English and Farsi, and finally, 15 articles were selected. RESULTS Results showed that nurses do not have appropriate viewpoint about visiting patients in ICUs, and they discussed and outlined the barriers of visiting patients given the benefits of family members' presence. CONCLUSION There are several limitations on the process of family members visiting their patients in the ICUs. It is essential to modify the nurses' attitudes and remove the organizational limitations in this area.
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Affiliation(s)
- Naiemeh Seyedfatemi
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Nooredin Mohammadi
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Hashemi
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Farrier CE, Stelfox HT, Fiest KM. In the pursuit of partnership: patient and family engagement in critical care medicine. Curr Opin Crit Care 2020; 25:505-510. [PMID: 31313682 DOI: 10.1097/mcc.0000000000000643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Patient and family partnership in critical care medicine research and clinical care is essential to achieve patient and family-centered care. Although there is an increasing interest in patient and family engagement, research is lacking to direct clinicians and researchers on how to provide opportunities for meaningful engagement. We review the recent literature and provide examples from our own experiences to guide all parties in this important and emerging area. RECENT FINDINGS Though the literature is relatively nascent, studies suggest that there is a desire to engage patients and families in critical care medicine research and clinical care, however, uncertainty exists on how to achieve this goal. Engagement exists on a spectrum from presence to shared decision-making and direct contributions to care; most engagement in critical care medicine involves participation in research and presence at the bedside. Expectation management is essential for meaningful engagement and true partnership. Challenges to patient and family engagement exist, including determining appropriate compensation, aligning engagement with needs and skills, and recruitment, training and retention. These challenges can be mitigated with thoughtful planning and management. SUMMARY Patient and family engagement in critical care medicine is an emerging field that requires further study to support definitive conclusions. Until then, it is important to match interested patients and family members with appropriate opportunities and provide training and support to ensure meaningful engagement.
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Affiliation(s)
- Christian E Farrier
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary.,Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary.,Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary.,Department of Psychiatry and Hotchkiss Brain Institute, University of Calgary
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Family participation in the care of older adult patients admitted to the intensive care unit: A scoping review. Geriatr Nurs 2020; 41:474-484. [PMID: 32059826 DOI: 10.1016/j.gerinurse.2020.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 12/28/2022]
Abstract
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.
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Østergaard B, Clausen AM, Agerskov H, Brødsgaard A, Dieperink KB, Funderskov KF, Nielsen D, Sorknaes AD, Voltelen B, Konradsen H. Nurses' attitudes regarding the importance of families in nursing care: A cross-sectional study. J Clin Nurs 2020; 29:1290-1301. [PMID: 31971287 DOI: 10.1111/jocn.15196] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/05/2020] [Accepted: 01/10/2020] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To investigate attitudes towards family involvement in care among a broad sample of Danish nurses from all sectors and healthcare settings. BACKGROUND Evidence suggests that nurses hold both supportive and less supportive attitudes about involvement of family members in the care of patients, and the existing findings are limited to specific healthcare contexts. DESIGN A cross-sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology for reporting observational studies. METHODS Using snowball sampling, the Families' Importance in Nursing Care-Nurses' Attitudes questionnaire was initially administered to a broad, convenience sample of Danish registered nurses through social media: Facebook interest groups and the homepage of the Danish Family Nursing Association. These nurses were encouraged to send the invitation to participate in their network of nursing colleagues. Complete data sets from 1,720 nurses were available for analysis. RESULTS In general, the nurses considered the family as important in patient care. Nurses who held master's and doctorate degrees scored significantly higher than nurses with a basic nursing education. Nurses who had had experience with illness within their own families tended to score higher on the family as a conversational partner subscale than those without this experience. Nurses with the longest engagement within hospital settings scored significantly lower than those with the longest engagement within primary health care and/or psychiatry. CONCLUSIONS Families are considered important in nursing care. Younger nurses with a basic education, short-term engagement at a hospital and no experiences with illness within their own families were predictors of less supportive attitudes towards including the family in nursing care. RELEVANCE TO CLINICAL PRACTICE Clinical leaders and managers should promote education on the importance of active family involvement in patient care in clinical practice and undergraduate education. More focus on collaboration with families in the hospital setting is needed.
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Affiliation(s)
- Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne M Clausen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Anne Brødsgaard
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark.,Section for Nursing, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Karen F Funderskov
- Department of Clinical Physiology, Danish Center for Sleep Medicine - Rigshospitalet, Copenhagen, Denmark
| | - Dorthe Nielsen
- Migrant Health Clinic, Department of Infectious diseases, Odense University Hospital, Odense, Denmark.,Department of Nursing/Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Anne D Sorknaes
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Medical Department, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
| | - Barbara Voltelen
- Department of Nursing/Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Hanne Konradsen
- Department of Gastroenterology, Herlev and Gentofte University Hospital, Hellerup, Denmark.,Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Instituttet, Solna, Sweden.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Imanipour M, Kiwanuka F. Family nursing practice and family importance in care – Attitudes of nurses working in intensive care units. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hestevik CH, Molin M, Debesay J, Bergland A, Bye A. Hospital nurses and home care providers’ experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study. J Hum Nutr Diet 2019; 33:198-206. [DOI: 10.1111/jhn.12729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- C. H. Hestevik
- Department of Physiotherapy Faculty of Health Sciences OsloMet–Oslo Metropolitan University Oslo Norway
| | - M. Molin
- Department of Nursing and Health Promotion Faculty of Health Sciences OsloMet – Oslo Metropolitan University Oslo Norway
- Bjorknes University College Oslo Norway
| | - J. Debesay
- Department of Nursing and Health Promotion Faculty of Health Sciences OsloMet – Oslo Metropolitan University Oslo Norway
| | - A. Bergland
- Department of Physiotherapy Faculty of Health Sciences OsloMet–Oslo Metropolitan University Oslo Norway
| | - A. Bye
- Department of Nursing and Health Promotion Faculty of Health Sciences OsloMet – Oslo Metropolitan University Oslo Norway
- Regional Advisory Unit in Palliative Care Department of Oncology Oslo University Hospital Oslo Norway
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Imanipour M, Kiwanuka F, Akhavan Rad S, Masaba R, Alemayehu YH. Family members' experiences in adult intensive care units: a systematic review. Scand J Caring Sci 2019; 33:569-581. [PMID: 30866085 DOI: 10.1111/scs.12675] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Admission to Intensive Care Units (ICU) exposures family members to a new environment, advanced monitoring systems and aggressive treatments. This is coupled with the critical condition of the patient being admitted in ICU. In such times of stress and crisis, families have varying experiences as they navigate the ICU journey. These happen more or less in chronological phases. AIM This review sought to describe the experiences of family members of patients admitted in adult ICUs. DATA SOURCES Four electronic databases (PubMed, Embase, Scopus and Web of Science) were searched, using keywords and free-text words. METHODS Curation of the review question involved problem identification, a scoping search, developing a search strategy, evaluation, data analysis, and reporting. Freehand search in reference lists of eligible articles was also done to obtain potentially eligible articles published in English language between 2007 and 2018. Studies were included if they reported on family members' experiences in adult ICUs. This review conforms to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). RESULTS Upon completion of the screening process, 28 studies were included. Most studies were conducted in the United States while no study was identified from Africa. We report on 717 family members. Family members' experience of the ICU journey falls into three main themes: (i) Floating, (ii) Probing and (iii) Continuity or Closure. CONCLUSION As healthcare technology advances, the ICU environment consequently needs to evolve. As such, healthcare providers will need to adjust their practice, support and consider the patients' family as the other part of the patient and members of the care team in order to meet their expectations. Further research highlighting family members' experience of the ICU journey in Africa is needed.
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Affiliation(s)
- Masoomeh Imanipour
- Nursing and Midwifery Care Research Center.,Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Frank Kiwanuka
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | | | - Ronald Masaba
- School of Nursing, Clarke International University, Kampala, Uganda
| | - Yisak Hagos Alemayehu
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Ayder Comprehensive Specialized Hospital, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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McAndrew NS, Schiffman R, Leske J. Relationships among Climate of Care, Nursing Family Care and Family Well-being in ICUs. Nurs Ethics 2019; 26:2494-2510. [PMID: 30832534 DOI: 10.1177/0969733019826396] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frequent exposure to ethical conflict and a perceived lack of organizational support to address ethical conflict may negatively influence nursing family care in the intensive care unit. RESEARCH AIMS The specific aims of this study were to determine: (1) if intensive care unit climate of care variables (ethical conflict, organizational resources for ethical conflict, and nurse burnout) were predictive of nursing family care and family wellbeing and (2) direct and indirect effects of the climate of care on the quality of nursing family care and family wellbeing. RESEARCH DESIGN A cross-sectional, correlational design was used. PARTICIPANTS AND RESEARCH CONTEXT Convenience sample of 111 nurses and 44 family members from five intensive care units at a Midwest hospital in the United States. INSTRUMENTS The Ethical Conflict Questionnaire-Critical Care Version, Maslach Burnout Inventory-Human Services Survey and Hospital Ethical Climate Scale were used to measure climate of care. The Family-Centered Care-Adult Version and Nurse Provided Family Social Support Scale were family measures of the quality of nursing family care. The Family Wellbeing Index was used to measure family wellbeing. DATA ANALYSIS Hierarchical regression and mediation analysis were used to answer the study aims. ETHICAL CONSIDERATIONS The study was approved by the Institutional Review Board at the study site. FINDINGS In separate regression models, organizational resources for ethical conflict (β = .401, p = .006) and depersonalization (β = -.511, p = .006), a component of burnout, were significant predictors of family-centered care. In simple mediation analysis the relationship between organizational resources for ethical conflict and family-centered care was mediated by depersonalization (β = .341, 95% confidence interval (.015, .707)). DISCUSSION Inadequate organizational resources and depersonalization may be related to family care delivery, and present obstacles to family-centered care in the intensive care unit. CONCLUSION Further research to explicate the relationships among organizational resources, ethical conflict, burnout, and family-centered care is needed to guide the development of effective interventions that enhance the quality of nursing family care in the intensive care unit.
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Affiliation(s)
| | | | - Jane Leske
- Froedtert & the Medical College of Wisconsin Froedtert Hospital
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Minton C, Batten L, Huntington A. A multicase study of prolonged critical illness in the intensive care unit: Families' experiences. Intensive Crit Care Nurs 2018; 50:21-27. [PMID: 30297150 DOI: 10.1016/j.iccn.2018.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/13/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is widely acknowledged a critical illness is a stressful life event for not only the patient but also their family members; when an illness becomes prolonged, the impact is profound. It is suggested that as medical technologies advance, the number of days patients stay in an intensive care unit will increase. Therefore, it is important nurses understand how families experience a prolonged critical illness of their family member in an intensive care unit. OBJECTIVE To explore the trajectory of a prolonged critical illness in the intensive care unit from the experiences of family. METHODS A qualitative, longitudinal, multi-case design consisting of six cases from New Zealand intensive care units. Findings presented in this article only relate to the family's experiences, although patients and healthcare professionals formed part of each case. Data collection methods included observation, conversations, interviews and document review. Analysis was undertaken using thematic analysis, vignette development and trajectory mapping. FINDINGS Relentless uncertainty dominated all phases of the trajectory for the family during a family member's prolonged critical illness in the intensive care unit. When faced with a critical illness, family shifted rapidly into a world of unknowns. Family worked hard to navigate their way through the many uncertainties that dominated each phase of their family member's illness. CONCLUSIONS Nurses need to understand the levels of uncertainty families endure in order to provide care that meets the philosophical underpinnings of family centred care.
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Affiliation(s)
- Claire Minton
- School of Nursing, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.
| | - Lesley Batten
- College of Health, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.
| | - Annette Huntington
- School of Nursing, Massey University, PO Box 756, Wellington, New Zealand.
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Meiers SJ, Eggenberger SK, Krumwiede N. Development and Implementation of a Family-Focused Undergraduate Nursing Curriculum: Minnesota State University, Mankato. JOURNAL OF FAMILY NURSING 2018; 24:307-344. [PMID: 30101655 DOI: 10.1177/1074840718787274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Nurse educators have the responsibility to create learning experiences centered on the scientific and praxis foci of the nursing discipline to advance nursing practice with families. Although the nursing profession has ample knowledge about the importance of family nursing and the value of family-focused actions, there is a lack of curricular and teaching models that address nursing practice with families in numerous courses and learning experiences. This article describes the development of a family-focused undergraduate curriculum and teaching-learning practices at Minnesota State University, Mankato in the United States. A vision and mission centered on the nursing of families, a family care teaching model, a framework of family constructs, and taxonomy of significant learning strategies guided faculty in creating learner-centered experiences. Course objectives, competencies, and teaching-learning practices in this curriculum are described. This manuscript may guide the development of innovative teaching-learning practices that integrate family nursing constructs and family nursing actions from a variety of family nursing models and theories. Initial evaluation suggests that this curriculum can increase students' knowledge of family and instill a passion for family care in undergraduate programs.
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Abstract
OBJECTIVE The aims of this study were to illustrate the quality, safety, cost-effectiveness, and ethics of consumer engagement initiatives and identify promising practices and leadership strategies used by nursing leaders. METHODS A literature review was performed with supplementary interviews conducted with 25 key nursing informants including nursing executives and chief nursing officers at acute care hospitals, community health centers, policy institutions, and quality and safety organizations. A narrative synthesis approach was used to identify and compare existing measures of consumer engagement and compassionate care in acute care settings. One-hour semistructured interviews were performed, and information was gathered by notes and audio recordings. RESULTS Consumer engagement activities focusing on compassionate patient and provider interactions involving patients and family as partners on the care team are associated with increases in treatment savings and patient safety in terms of length of stay and reduced medication errors. Engagement initiatives support employee health and reduce compassion fatigue. CONCLUSION Findings illustrate the impact of patients and family engagement in decision making and promising organizational practices that reinforce engagement.
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Affiliation(s)
- Susan Hassmiller
- Author Affiliations: Senior Adviser for Nursing and Director of Future of Nursing: Campaign for Action (Dr Hassmiller) and Nursing Intern (Ms. Bilazarian), Robert Wood Johnson Foundation, Princeton, New Jersey; Staff Nurse (Ms Bilazarian), Emergency Department, New York-Presbyterian/Weill Cornell Medical Center
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"Sedation is tricky": A qualitative content analysis of nurses' perceptions of sedation administration in mechanically ventilated intensive care unit patients. Aust Crit Care 2018; 31:153-158. [PMID: 29571595 DOI: 10.1016/j.aucc.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Critical care nurses are responsible for administering sedative medications to mechanically ventilated patients. With significant advancements in the understanding of the impact of sedative exposure on physiological and psychological outcomes of ventilated patients, updated practice guidelines for assessment and management of pain, agitation, and delirium in the intensive care unit were released in 2013. The primary aim of this qualitative study was to identify and describe themes derived from critical care nurses' comments regarding sedation administration practices with mechanically ventilated patients. METHODS This is a qualitative content analysis of secondary text data captured through a national electronic survey of members of the American Association of Critical-Care Nurses. A subsample (n = 67) of nurses responded to a single, open-ended item at the end of a survey that evaluated nurses' perceptions of current sedation administration practices. FINDINGS Multiple factors guided sedation administration practices, including individual patient needs, nurses' synthesis of clinical evidence, application of best practices, and various personal and professional practice perspectives. Our results also indicated nurses desire additional resources to improve their sedation administration practices including more training, better communication tools, and adequate staffing. CONCLUSIONS Critical care nurses endorse recommendations to minimise sedation administration when possible, but a variety of factors, including personal perspectives, impact sedation administration in the intensive care unit and need to be considered. Critical care nurses continue to encounter numerous challenges when assessing and managing sedation of mechanically ventilated patients.
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