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Pattison N. Critical care outreach and rapid response teams: Are they the panacea to all hospital patient deterioration problems? Intensive Crit Care Nurs 2024; 82:103643. [PMID: 38394981 DOI: 10.1016/j.iccn.2024.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- Natalie Pattison
- University of Hertfordshire, East and North Herts NHS Trust, Imperial College Healthcare NHS Trust, Imperial College London, UK.
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2
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Montgomery CM, Docherty AB, Humphreys S, McCulloch C, Pattison N, Sturdy S. Remaking critical care: Place, body work and the materialities of care in the COVID intensive care unit. Sociol Health Illn 2024; 46:361-380. [PMID: 37702219 DOI: 10.1111/1467-9566.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
In this article, we take forward sociological ways of knowing care-in-practice, in particular work in critical care. To do so, we analyse the experiences of staff working in critical care during the first wave of the COVID-19 pandemic in the UK. This moment of exception throws into sharp relief the ways in which work and place were reconfigured during conditions of pandemic surge, and shows how critical care depends at all times on the co-constitution of place, practices and relations. Our analysis draws on sociological and anthropological work on the material culture of health care and its sensory instantiations. Pursuing this through a study of the experiences of 40 staff across four intensive care units (ICUs) in 2020, we provide an empirical and theoretical elaboration of how place, body work and care are mutually co-constitutive. We argue that the ICU does not exist independently of the constant embodied work of care and place-making which iteratively constitute critical care as a total system of relations.
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Affiliation(s)
- Catherine M Montgomery
- Science, Technology & Innovation Studies, University of Edinburgh, Edinburgh, UK
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Diagnostics, Anaesthetics, Theatres and Critical Care, NHS Lothian, Edinburgh, UK
| | - Sally Humphreys
- Critical Care and Research & Development, West Suffolk NHS Foundation Trust, Suffolk, UK
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Corrienne McCulloch
- Diagnostics, Anaesthetics, Theatres and Critical Care, NHS Lothian, Edinburgh, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
- Nursing, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Steve Sturdy
- Science, Technology & Innovation Studies, University of Edinburgh, Edinburgh, UK
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
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3
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Wythe H, Attavar R, Jones J, Kelly J, Palmer C, Jenkins L, Dekker R, Fearns D, Watkins S, Hunt A, Pattison N. Evaluating the usefulness of a wordless picture book for adults with intellectual disabilities about the COVID-19 vaccination programme using co-production: The CAREVIS study. J Appl Res Intellect Disabil 2024; 37:e13203. [PMID: 38369311 DOI: 10.1111/jar.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/06/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024]
Abstract
AIM To explore the usefulness of a co-designed wordless book showing processes of receiving COVID-19 vaccines designed by, and for, adults with intellectual disabilities. METHODS A qualitative evaluation of the resource using mixed methods. Semi-structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. RESULTS Understanding the COVID-19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID-19 restrictions changing. CONCLUSION A visual resource may help conversations about the COVID-19 vaccine for people with intellectual disabilities.
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Affiliation(s)
- Helena Wythe
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Raj Attavar
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Julia Jones
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Jackie Kelly
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | | | | | | | - Debra Fearns
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Scott Watkins
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Anne Hunt
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
- East and North Hertfordshire NHS Trust, Hertfordshire, UK
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Bunting A, Palmer C, Attavar R, Wythe H, Pattison N. Adaptations to research within the intellectual disability population during the COVID-19 pandemic: Lessons learned from the CAREVIS study. J Intellect Disabil 2024; 28:285-291. [PMID: 37864555 DOI: 10.1177/17446295231210041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
The COVID-19 pandemic resulted in changes in all areas of clinical practice, including clinical research and within the intellectual disability population. While there have been some benefits from this rapid adoption of change, those involved in research have had to overcome a number of additional challenges. These adaptive changes, which have included the use of technology, closure of social spaces, working with specific groups who are more vulnerable to COVID-19, and mask use impairing communication, have had both positive and negative impacts on research. As the pandemic and related restrictions evolve, it is important to examine the changes that have occurred. In the future, the adoption of a hybrid model in research is likely to be a common approach, establishing a balance between technology and in-person interaction.
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Affiliation(s)
- Apphia Bunting
- Hertfordshire Partnership University NHS Foundation Trust, Aylesbury, UK
| | - Claire Palmer
- Hertfordshire Partnership University NHS Foundation Trust, Aylesbury, UK
| | - Rajnish Attavar
- Hertfordshire Partnership University NHS Foundation Trust, Aylesbury, UK
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Allum L, Terblanche E, Pattison N, Connolly B, Rose L. Clinician views on actionable processes of care for prolonged stay intensive care patients and families: A descriptive qualitative study. Intensive Crit Care Nurs 2024; 80:103535. [PMID: 37801854 DOI: 10.1016/j.iccn.2023.103535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES To explore clinician perspectives on key actionable processes of care that may improve outcomes and experience of patients experiencing a prolonged (over 7 days) intensive care unit stay, and their family members. RESEARCH METHODOLOGY A descriptive qualitative interview study in the United Kingdom. We conducted online semi-structured interviews using video conferencing software (October 2020-August 2022). We used purposive sampling ensuring participation from a broad range of professions representing the interprofessional team in the United Kingdom. We used Framework Analysis methods to group actionable processes into the six themes of person-centred care. Analyses were informed by our previous scoping review and previous interviews with former patients and family members. FINDINGS We interviewed 24 staff participants and identified 36 actionable processes of care under six themes of person-centred care. Processes relating to communication (both establishing an effective communication method for the patient and staff communication with the patient and family), continuity of staff and care plans, and personalising the environment and routines, and allowing flexible family visiting were most frequently articulated. These processes were perceived as having a multifaceted impact on patient and family wellbeing, for example family visiting helping patient and family emotional wellbeing and staff communication with family; and establishing an effective communication method for patients reduced their anxiety, enhanced their involvement in their care and allowed staff to include them in ward rounds more efficiently. CONCLUSION We identified 36 actionable processes of care from interviews with intensive care staff, with an emphasis on enhancing patient autonomy through optimising communication and involvement in decision-making, participation of family, and continuity of staff and care plans. IMPLICATIONS FOR CLINICAL PRACTICE These 36 actionable processes of care will contribute to future development of quality improvement tools, which will be used to standardise the care of prolonged-stay intensive care patients and their families.
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Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
| | - Ella Terblanche
- Nutrition and Dietetic Department, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London.
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East & North Herts NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK.
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Centre for Human and Applied Physiological Sciences, King's College London, UK; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Department of Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
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Bates A, Golding H, Rushbrook S, Highfield J, Pattison N, Baldwin D, Grocott MPW, Cusack R. Mixed-methods randomised study exploring the feasibility and acceptability of eye-movement desensitisation and reprocessing for improving the mental health of traumatised survivors of intensive care following hospital discharge: protocol. BMJ Open 2024; 14:e081969. [PMID: 38286705 PMCID: PMC10826543 DOI: 10.1136/bmjopen-2023-081969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Post-traumatic symptoms are common among patients discharged from intensive care units (ICUs), adversely affecting well-being, increasing healthcare utilisation and delaying return to work. Non-pharmacological approaches (eg, music, therapeutic touch and patient diaries) have been suggested as candidate interventions and trauma-focused psychological interventions have been endorsed by international bodies. Neither category of intervention is supported by definitive evidence of long-term clinical effectiveness in patients who have been critically ill. This study assesses the feasibility and acceptability of using eye-movement desensitisation and reprocessing (EMDR) to improve the mental health of ICU survivors. METHODS AND ANALYSIS EMERALD is a multicentre, two-part consent, pilot feasibility study, recruiting discharged ICU survivors from three hospitals in the UK. We are gathering demographics and measuring post-traumatic symptoms, anxiety, depression and quality of life at baseline. Two months after discharge, participants are screened for symptoms of post-traumatic stress disorder (PTSD) using the Impact of Events Scale-Revised (IES-R). Patients with IES-R scores<22 continue in an observation arm for 12 month follow-up. IES-R scores≥22 indicate above-threshold PTSD symptoms and trigger invitation to consent for part B: a randomised controlled trial (RCT) of EMDR versus usual care, with 1:1 randomisation. The study assesses feasibility (recruitment, retention and intervention fidelity) and acceptability (through semistructured interviews), using a theoretical acceptability framework. Clinical outcomes (PTSD, anxiety, depression and quality of life) are collected at baseline, 2 and 12 months, informing power calculations for a definitive RCT, with quantitative and qualitative data convergence guiding RCT refinements. ETHICS AND DISSEMINATION This study has undergone external expert peer review and is funded by the National Institute for Health and Care Research (grant number: NIHR302160). Ethical approval has been granted by South Central-Hampshire A Research Ethics Committee (IRAS number: 317291). Results will be disseminated through the lay media, social media, peer-reviewed publication and conference presentation. TRIAL REGISTRATION NUMBER NCT05591625.
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Affiliation(s)
- Andrew Bates
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hannah Golding
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Natalie Pattison
- University of Hertfordshire, Hatfield, UK
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - David Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Michael P W Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rebecca Cusack
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
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Dewa LH, Thibaut B, Pattison N, Campbell SJ, Woodcock T, Aylin P, Archer S. Treating insomnia in people who are incarcerated: a feasibility study of a multicomponent treatment pathway. Sleep Adv 2024; 5:zpae003. [PMID: 38370440 PMCID: PMC10873789 DOI: 10.1093/sleepadvances/zpae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/11/2023] [Indexed: 02/20/2024]
Abstract
Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardized, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomized controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes. We used a within-participants pre-post design. The stepped-care pathway included: self-management with peer support, environmental aids, and cognitive behavioral therapy for insomnia (CBTi). Assessment measures for insomnia, well-being, mood, anxiety, suicidality, overall health, sleepiness, fatigue, and cognitive functioning were administered at baseline and pathway exit. Feasibility criteria included eligibility to participate, CBTi uptake, and assessment completion. Forty-two adult males who are incarcerated were approached of which 95.2% were eligible. Of those deemed eligible, most participated (36/40, 90.0%). Most who completed baseline completed post-assessments (28/36, 77.8%) and of these, most showed improvements in their subjective sleep (27/28, 96.4%). Large reductions were found from pre- to posttreatment in insomnia severity (d = -1.81, 95% CI: 8.3 to 12.9) and 57.0% reported no clinically significant insomnia symptoms at post-assessment. There was no overall change in actigraphy-measured sleep. Large treatment benefits were found for depression, anxiety, well-being, and cognitive functioning, with a medium benefit on suicidal ideation. The treatment pathway for insomnia in prison was feasible and may be an effective treatment for insomnia in people who are incarcerated, with additional promising benefits for mental health. A pragmatic RCT across different prison populations is warranted. This paper is part of the Sleep and Circadian Health in the Justice System Collection.
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Affiliation(s)
- Lindsay H Dewa
- Imperial College London, School of Public Health, London, UK
| | - Bethan Thibaut
- Imperial College London, School of Public Health, London, UK
| | | | | | - Thomas Woodcock
- Imperial College London, School of Public Health, London, UK
| | - Paul Aylin
- Imperial College London, School of Public Health, London, UK
| | - Stephanie Archer
- University of Cambridge, Department of Public Health and Primary Care, UK
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8
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Pattison N, O'Gara G, Thomas K, Wigmore T, Dyer J. An aromatherapy massage intervention on sleep in the ICU: A randomized controlled feasibility study. Nurs Crit Care 2024; 29:14-21. [PMID: 37533150 DOI: 10.1111/nicc.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
We conducted a feasibility randomized controlled trial exploring the effect of aromatherapy massage on sleep in critically ill patients. Patients were randomized to receive aromatherapy massage or usual care, and feasibility of recruitment and outcome data completion was captured. Sleep (depth) was assessed through Bispectral Index monitoring and self/nurse-reported Richards-Campbell Sleep Questionnaires, and the Sleep in the ICU Questionnaire. Thirty-four patients participated: 17 were randomized to aromatherapy massage and 17 to control. Five participants who received the intervention completed outcomes for analysis (alongside eight controls). A larger study was deemed unfeasible in this population, highlighting the value of testing feasibility of complex interventions, such as massage for sleep in ICU.
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Affiliation(s)
- Natalie Pattison
- University of Hertfordshire, Hatfield, UK
- East and North Herts NHS Trust, Stevenage, UK
| | | | - Karen Thomas
- Intensive Care National Audit and Research Centre, London, UK
| | - Tim Wigmore
- Royal Marsden NHS Foundation Trust, London, UK
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Almomani E, Sullivan J, Saadeh O, Mustafa E, Pattison N, Alinier G. Reflective learning conversations model for simulation debriefing: a co-design process and development innovation. BMC Med Educ 2023; 23:837. [PMID: 37936185 PMCID: PMC10631178 DOI: 10.1186/s12909-023-04778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Health practitioners must be equipped with effective clinical reasoning skills to make appropriate, safe clinical decisions and avoid practice errors. Under-developed clinical reasoning skills have the potential to threaten patient safety and delay care or treatment, particularly in critical and acute care settings. Simulation-based education which incorporates post-simulation reflective learning conversations as a debriefing method is used to develop clinical reasoning skills while patient safety is maintained. However, due to the multidimensional nature of clinical reasoning, the potential risk of cognitive overload, and the varying use of analytic (hypothetical-deductive) and non-analytic (intuitive) clinical reasoning processes amongst senior and junior simulation participants, it is important to consider experience, competence, flow and amount of information, and case complexity related factors to optimize clinical reasoning while attending group- based post-simulation reflective learning conversations as a debriefing method. We aim to describe the development of a post-simulation reflective learning conversations model in which a number of contributing factors to achieve clinical reasoning optimization were addressed. METHODS A Co-design working group (N = 18) of doctors, nurses, researchers, educators, and patients' representatives collaboratively worked through consecutive workshops to co-design a post-simulation reflective learning conversations model to be used for simulation debriefing. The co-design working group established the model through a theoretical and conceptual-driven process and multiphasic expert reviews. Concurrent integration of appreciative inquiry, plus/delta, and Bloom's Taxonomy methods were considered to optimize simulation participants' clinical reasoning while attending simulation activities. The face and content validity of the model were established using the Content Validity Index CVI and Content Validity Ratio CVR methods. RESULTS A Post-simulation reflective learning conversations model was developed and piloted. The model was supported with worked examples and scripted guidance. The face and content validity of the model were evaluated and confirmed. CONCLUSIONS The newly co-designed model was established in consideration to different simulation participants' seniority and competence, flow and amount of information, and simulation case complexity. These factors were considered to optimize clinical reasoning while attending group-based simulation activities.
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Affiliation(s)
- Emad Almomani
- Hamad Medical Corporation, HMC-Qatar, PO Box: 3050, Doha, Qatar.
| | | | - Omar Saadeh
- Hamad Medical Corporation, HMC-Qatar, PO Box: 3050, Doha, Qatar
| | - Emad Mustafa
- Hamad Medical Corporation, HMC-Qatar, PO Box: 3050, Doha, Qatar
| | - Natalie Pattison
- University of Hertfordshire-School of Health and Social Work, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Guillaume Alinier
- Hamad Medical Corporation, HMC-Qatar, PO Box: 3050, Doha, Qatar
- University of Hertfordshire-School of Health and Social Work, Hatfield, Hertfordshire, AL10 9AB, UK
- Weill Cornell Medicine-Qatar, Doha, Qatar
- Northumbria University, Newcastle, UK
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10
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Bates A, Golding H, Rushbrook S, Shapiro E, Pattison N, Baldwin DS, Grocott MPW, Cusack R. A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19. J Intensive Care Soc 2023; 24:309-319. [PMID: 37744073 PMCID: PMC9679313 DOI: 10.1177/17511437221136828] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Approximately 50% of intensive care survivors experience persistent psychological symptoms. Eye-movement desensitisation and reprocessing (EMDR) is a widely recommended trauma-focussed psychological therapy, which has not been investigated systematically in a cohort of intensive care survivors: We therefore conducted a randomised pilot feasibility study of EMDR, using the Recent Traumatic Episode Protocol (R-TEP), to prevent psychological distress in intensive care survivors. Findings will determine whether it would be possible to conduct a fully-powered clinical effectiveness trial and inform trial design. Method We aimed to recruit 26 patients who had been admitted to intensive care for over 24 h with COVID-19 infection. Consenting participants were randomised (1:1) to receive either usual care plus remotely delivered EMDR R-TEP or usual care alone (controls). The primary outcome was feasibility. We also report factors related to safety and symptom changes in post-traumatic stress disorder, (PTSD) anxiety and depression. Results We approached 51 eligible patients, with 26 (51%) providing consent. Intervention adherence (sessions offered/sessions completed) was 83%, and 23/26 participants completed all study procedures. There were no attributable adverse events. Between baseline and 6-month follow-up, mean change in PTSD score was -8 (SD = 10.5) in the intervention group versus +0.75 (SD = 15.2) in controls (p = 0.126). There were no significant changes to anxiety or depression. Conclusion Remotely delivered EMDR R-TEP met pre-determined feasibility and safety objectives. Whilst we achieved group separation in PTSD symptom change, we have identified a number of protocol refinements that would improve the design of a fully powered, multi-centre randomised controlled trial, consistent with currently recommended rehabilitation clinical pathways. Trial registration ClinicalTrials.gov: NCT04455360.
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Affiliation(s)
- Andrew Bates
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hannah Golding
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
| | - Sophie Rushbrook
- Intensive Psychological Therapies Service, Dorset Healthcare University National Health Service Foundation Trust, Poole, UK
| | - Elan Shapiro
- Independent EMDR Europe Consultant Practitioner, Haifa, Israel
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - David S Baldwin
- Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Michael P W Grocott
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rebecca Cusack
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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Dogan B, Pattison N, Scott R, Alinier G. A protocol for a scoping review of the use of mental simulation and full-scale simulation in practising healthcare decision-making skills of undergraduate nursing students. Nurse Educ Pract 2023; 71:103699. [PMID: 37441918 DOI: 10.1016/j.nepr.2023.103699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
AIM This scoping review aims to explore the effect of FSS and mental simulation on the decision-making skills of nursing students. BACKGROUND Full-scale simulation (FSS) has been the most used simulation modality in nursing education due to its applicability to enhance both technical and non-technical skills. However, FSS can be excessively costly and other factors such as technophobia and lack of trained staff and support make FSS less accessible, especially for nursing education. Therefore, a novel mental simulation that is interactive and supported by visual elements can be a substitute for FSS, at least for some of the skills, such as clinical decision-making. Reviews comparing the effectiveness of FSS and mental simulation on decision-making skills in nursing students are lacking. Further knowledge on the effectiveness of these two modalities on decision-making skills for nursing students is needed to inform the nursing education curriculum and to decide between the two modalities. DESIGN This protocol adheres to the guidelines outlined in the PRISMA extension for scoping reviews (PRISMA-scr) checklist. METHOD The methodological framework for scoping reviews will be followed for this scoping review. Scopus, EBSCOhost the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE and for the grey literature ERIC and BASE will be searched for related studies. The search will be limited to January 2008 and April 2023 (up-to-date) and English. A detailed search strategy was developed with an experienced research information manager and this strategy will be adapted to each database. A single screening will be performed by an author who will screen all abstracts and titles and full-text publications. After the study selection step of the framework, the data from the included studies will be charted using a data extraction form. The data will be synthesised by comparing the effect of FSS and mental simulation on decision-making skills. CONCLUSION A synopsis of the publication on FSS and mental simulation on nurse students' decision-making skills will be useful for stakeholders when choosing between two modalities to deliver decision-making skills to nursing students and also help to inform the nursing education and simulation practice. SCOPING REVIEW REGISTRATION Protocols.io (doi: 10.17504/protocols.io.e6nvw57y7vmk/v1).
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Affiliation(s)
- Burcu Dogan
- School of Health and Social Work University of Hertfordshire Hatfield, Hertfordshire, UK
| | - Natalie Pattison
- School of Health and Social Work University of Hertfordshire Hatfield, Hertfordshire, UK; East & North Herts NHS Trust Stevenage, UK.
| | - Rebecca Scott
- School of Health and Social Work University of Hertfordshire Hatfield, Hertfordshire, UK
| | - Guillaume Alinier
- School of Health and Social Work University of Hertfordshire Hatfield, Hertfordshire, UK; Hamad Medical Corporation Ambulance Service Doha, Qatar; Weill Cornell Medicine - Qatar Doha, Qatar; Faculty of Health and Life Sciences, Northumbria University Newcastle Upon Tyne, UK
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12
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Pattison N, Corser R. Compassionate, collective or transformational nursing leadership to ensure fundamentals of care are achieved: A new challenge or non-sequitur? J Adv Nurs 2023; 79:942-950. [PMID: 35301739 DOI: 10.1111/jan.15202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/18/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
AIMS This discursive paper draws on three key leadership theories with the aim of outlining how styles of leadership impact the provision of fundamentals of care. DESIGN Discussion paper. DATA SOURCES key leadership theories, leadership and fundamentals of care literature. IMPLICATIONS FOR NURSING The conceptualization of fundamentals of care is viewed through the lens of nursing leadership, and collective, compassionate and transformational leadership theory. The cognitive dissonance that nursing leaders encounter when trying to reconcile organizational, patient and nurses' needs is considered, and the pressure to deliver high-quality fundamentals of care presents a challenge to nurse leaders. CONCLUSION Leaders must align nursing and patient outcome data to drive forward and prioritize fundamental care. Focusing on key elements of relational leadership styles will ensure a workforce fit to provide fundamental care, which in the current climate must be an organizational and global nursing priority. IMPACT This discussion attempts to draw together overlapping leadership theories, emphasizes the importance of relational leadership in ensuring the provision of the fundamentals of care and acknowledged the impact of the COVID-19 pandemic on nurses and nursing care, with leadership implications outlined, such as a need for role-modelling, understanding shared values and giving nurses a voice. It will have an impact on nurse leaders, but also on those nurses providing direct care by issuing a challenge for them to confront their own nurse leaders, and to ask that they better resolve competing needs of both the nursing workforce and patients.
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Meyer J, Pattison N, Apps C, Gager M, Waldmann C. Driving resumption after critical illness:A survey and framework analysis of patient experience and process. J Intensive Care Soc 2023; 24:9-15. [PMID: 36874292 PMCID: PMC9975808 DOI: 10.1177/17511437221099118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Adverse sequelae are common in survivors of critical illness. Physical, psychological and cognitive impairments can affect quality of life for years after the original insult. Driving is an advanced task reliant on complex physical and cognitive functioning. Driving represents a positive recovery milestone. Little is currently known about the driving habits of critical care survivors. The aim of this study was to explore the driving practices of individuals after critical illness. Methods: A purpose-designed questionnaire was distributed to driving licence holders attending critical care recovery clinic. Results: A response rate of 90% was achieved. 43 respondents declared their intention to resume driving. Two respondents had surrendered their licence on medical grounds. 68% had resumed driving by 3 months, 77% by 6 months, and 84% by 1 year. The median interval (range) between critical care discharge and resumption of driving was 8 weeks (1-52 weeks). Psychological, physical and cognitive barriers were cited by respondents as barriers to driving resumption. Eight themes regarding driving resumption were identified from the framework analysis under three core domains and included: psychological/cognitive impact on ability to drive (Emotional readiness and anxiety; Confidence; Intrinsic motivation; Concentration), physical ability to drive (Weakness and fatigue; Physical recovery), and supportive care and information needs to resume driving (Information/advice; Timescales). Conclusion: This study demonstrates that resumption of driving following critical illness is substantially delayed. Qualitative analysis identified potentially modifiable barriers to driving resumption.
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Affiliation(s)
- Joel Meyer
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Natalie Pattison
- Department of Health and Social Work, University of Hertfordshire, Hatfield, UK East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Chloe Apps
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Melanie Gager
- Department of Critical Care Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Carl Waldmann
- Department of Critical Care Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
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Newman H, Clunie G, Wallace S, Smith C, Martin D, Pattison N. What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and metasynthesis. J Crit Care 2022; 72:154145. [PMID: 36174431 DOI: 10.1016/j.jcrc.2022.154145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Tracheostomy is a common surgical procedure in ICU. Whilst often life-saving, it can have important impacts on patients. Much of the literature on tracheostomy focuses on timing and technique of insertion, risk factors and complications. More knowledge of patient experience of tracheostomy in ICU is needed to support person-centred care. MATERIALS AND METHODS Qualitative systematic review and metasynthesis of the literature on adult experience of tracheostomy in ICU. Comprehensive search of four bibliographic databases and grey literature. Title and abstract screening and full text eligibility was completed independently by two reviewers. Metasynthesis was achieved using thematic synthesis, supported by a conceptual framework of humanised care. RESULTS 2971 search returns were screened on title and abstract and 127 full texts assessed for eligibility. Thirteen articles were included for analysis. Five descriptive and three analytical themes were revealed. The over-arching theme was 'To be seen and heard as a whole person'. Patients wanted to be treated as a human, and having a voice made this easier. CONCLUSIONS Voice restoration should be given high priority in the management of adults with a tracheostomy in ICU. Staff training should focus on both technical skills and compassionate care to improve person-centred outcomes.
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Affiliation(s)
- Helen Newman
- University College London, Division of Surgery and Interventional Science, Royal Free Hospital, 3(rd) Floor, Pond Street, London NW3 2QG, UK; Therapies Department, Barnet Hospital, Royal Free London NHS Foundation Trust, Wellhouse Lane, Barnet EN5 3DJ, UK.
| | - Gemma Clunie
- Sackler MSK Lab, Department of Surgery and Cancer, Imperial College London, 2(nd) Floor, Michael Uren Building, White City Campus, W12 0BZ, UK; Speech and Language Therapy, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, W6 8RF, UK
| | - Sarah Wallace
- Department of Speech Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; Division of Infection Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Christina Smith
- Department of Language and Cognition, Psychology and Language Sciences, University College London, London, UK
| | - Daniel Martin
- University College London, Division of Surgery and Interventional Science, Royal Free Hospital, 3(rd) Floor, Pond Street, London NW3 2QG, UK; Peninsula Medical School, University of Plymouth, John Bull Building, Plymouth, Devon PL6 8BU, UK
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East and North Hertfordshire NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK
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Almomani E, Sullivan MJ, Saadeh O, Mustafa E, Pattison N, Alinier G. Co-design: a guided reflective learning conversation model for simulation-based education. Simul Healthc 2022. [DOI: 10.54531/rwpz1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The critical care environment is stressful with complex clinical cases and high levels of workload [1]. Adequate exposure to various clinical experiences is essential to develop effective clinical reasoning skills [2]. Taking into consideration the risk of clinical practice mistakes and the importance of patient safety, simulation is an effective method to immerse learners in scenarios that mimic clinical situations with focused learning opportunities. Guided reflection through reflective learning conversations following simulation activities is recognized as an effective method to develop clinical reasoning skills [3]. We describe a co-design process to develop a simulation guided reflective learning conversation model to optimize the clinical reasoning skills for critical care nurses attending simulation-based activities.
A co-design working group of 10 critical care nurses of varying levels of seniority, experience, nationality, and gender; two critical care doctors; three patient representatives; 2 researchers, and 5–6 critical care educators are working collaboratively to co-design the guided reflective learning conversation model, in which clinical reasoning can be optimized with consideration to a wide range of case complexity, subspecialty, and competence levels. The co-design working group is meeting online for 4–6 workshops of 4 hours. The co-design process is built on valid and reliable clinical reasoning and educational theoretical frameworks and models. The inputs to the process, exercises, and activities are taking place during the workshops and the outputs of the workshops are described to establish the co-design process. The final draft of the model will be validated and tested. The study sample will be grouped into experimental and control cohorts of critical care nurses who attend critical care simulation-based courses (N=300). Data will be collected through surveys, focus groups, and simulation-based objective assessment and observations. The study has received Institutional Review Board approval from the Hamad Medical Corporation Medical Research Centre (MRC-01-22-117) and the University of Hertfordshire (HSK/PGR/UH/04728).
The first draft of the co-design model is presented in
Simulation-Based Reflective Learning Conversation Model (SBRLCM) under development
Clinical reasoning is multidimensional with difficulty to structure and evaluate during debriefing. Developing a guided reflective learning conversation model in which clinical reasoning skills are actively and effectively embedded, would therefore enable critical care nurses developing clinical reasoning skills to meet the special demands of critical care.
1. Vahedian-Azimi A, Hajiesmaeili M, Kangasniemi M, Fornés-Vives J, Hunsucker RL, Rahimibashar F, Pourhoseingholi MA, Farrokhvar L, Miller AC. Effects of stress on critical care nurses: a national cross-sectional study. Journal of intensive care medicine. 2019;34(4):311–22.
2. Kang H, Kang HY. The effects of simulation-based education on the clinical reasoning competence, clinical competence, and educational satisfaction. Journal of the Korea Academia-Industrial cooperation Society. 2020;21(8):107–14.
3. Decker S, Alinier G, Crawford SB, Gordon RM, Jenkins D, Wilson C. Healthcare Simulation Standards of Best Practice
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Paddock K, Woolfall K, Kearney A, Pattison N, Frith L, Gamble C, Welters I, Trinder J, Young B. Learning from stakeholders to inform good practice guidance on consent to research in intensive care units: a mixed-methods study. BMJ Open 2022; 12:e066149. [PMID: 36375987 PMCID: PMC9664286 DOI: 10.1136/bmjopen-2022-066149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Obtaining informed consent from patients in intensive care units (ICUs) prior to enrolment in a study is practically and ethically complex. Decisions about the participation of critically ill patients in research often involve substitute decision makers (SDMs), such as a patient's relatives or doctors. We explored the perspectives of different stakeholder groups towards these consent procedures. DESIGN AND METHODS Mixed-methods study comprising surveys completed by ICU patients, their relatives and healthcare practitioners in 14 English ICUs, followed by qualitative interviews with a subset of survey participants. Empirical bioethics informed the analysis and synthesis of the data. Survey data were analysed using descriptive statistics of Likert responses, and analysis of interview data was informed by thematic reflective approaches. RESULTS Analysis included 1409 survey responses (ICU patients n=333, relatives n=488, healthcare practitioners n=588) and 60 interviews (ICU patients n=13, relatives n=30, healthcare practitioners n=17). Most agreed with relatives acting as SDMs based on the perception that relatives often know the patient well enough to reflect their views. While the practice of doctors serving as SDMs was supported by most survey respondents, a quarter (25%) disagreed. Views were more positive at interview and shifted markedly depending on particularities of the study. Participants also wanted reassurance that patient care was prioritised over research recruitment. Findings lend support for adaptations to consent procedures, including collaborative decision-making to correct misunderstandings of the implications of research for that patient. This empirical evidence is used to develop good practice guidance that is to be published separately. CONCLUSIONS Participants largely supported existing consent procedures, but their perspectives on these consent procedures depended on their perceptions of what the research involved and the safeguards in place. Findings point to the importance of explaining clearly what safeguards are in place to protect the patient.
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Affiliation(s)
- Katie Paddock
- Department of Childhood, Youth and Education Studies, Manchester Metropolitan University, Manchester, UK
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Anna Kearney
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Natalie Pattison
- East and North Hertfordshire National Health Service Trust, Hertfordshire, UK
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Lucy Frith
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, UK
| | - Carrol Gamble
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Ingeborg Welters
- Department of Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - John Trinder
- Ulster Hospital, Belfast, South Eastern Health & Social Services Trust, Belfast, Ireland
| | - Bridget Young
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Allum L, Apps C, Pattison N, Connolly B, Rose L. Informing the standardising of care for prolonged stay patients in the ICU: A scoping review of quality improvement tools. Intensive Crit Care Nurs 2022; 73:103302. [PMID: 35931596 DOI: 10.1016/j.iccn.2022.103302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To inform design of quality improvement (QI) tools specific to patients with prolonged intensive care unit (ICU) stay, we determined characteristics (format/content), development, implementation, and outcomes of published multi-component QI tools used in ICU irrespective of length of stay. RESEARCH METHODOLOGY Scoping review searching electronic databases, trial registries and grey literature (January 2000 to January 2022). RESULTS We screened 58,378 citations, identifying 96 studies. All tools were designed for use commencing at ICU admission except 3 tools implemented at 3, 5 or 14 days. We identified 32 studies of locally developed checklists, 28 goal setting/structured communication templates, 23 care bundles, and 9 studies of mixed format tools. Most (43 %) tools were designed for use during rounds, fewer tools were designed for use throughout the ICU day (27 %) or stay (9 %). Most studies (55 %) reported process objectives i.e., improving communication, care standardisation, or rounding efficiency. Most common clinical processes QI tools were used to standardise were sedation (62, 65 %), ventilation and weaning (55, 57 %), and analgesia management (58, 60 %). 44 studies reported the effect of the tool on patient outcomes. Of these, only two identified a negative effect - increased ICU length of stay and increased ICU days with pain and delirium. CONCLUSION Although we identified numerous QI tools for use in ICU settings, few were designed to specifically address actionable processes of care relevant to the unique needs of prolonged ICU stay patients. Tools that address these needs are urgently required. SYSTEMATIC REVIEW REGISTRATION The review protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE.
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Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
| | - Chloe Apps
- Critical Care Research Group and Physiotherapy Department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London SE1 7EH, UK.
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East & North Herts NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK.
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Centre for Human and Applied Physiological Sciences, King's College London, UK; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
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Rose L, Cook A, Onwumere J, Terblanche E, Pattison N, Metaxa V, Meyer J. Psychological distress and morbidity of family members experiencing virtual visiting in intensive care during COVID-19: an observational cohort study. Intensive Care Med 2022; 48:1156-1164. [PMID: 35913640 PMCID: PMC9340748 DOI: 10.1007/s00134-022-06824-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose During the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world introduced virtual visiting to mediate the psychological impact of in-person visiting restrictions. Our objective was to evaluate levels of distress, depression, anxiety, and stress among family members experiencing virtual visits. Methods Multi-centre prospective observational study recruiting adult family members of critically ill patients in the United Kingdom (UK) using a bespoke virtual visiting solution (aTouchAway). We recruited participants and administered validated questionnaires digitally via their aTouchAway account. Prior to first virtual visit, participants completed the Distress Thermometer (score range 0–10) and the Depression, Anxiety and Stress Scale (DASS)-21. Following first and subsequent virtual visits, participants repeated the Distress Thermometer and completed the Discrete Emotions Questionnaire. Results We recruited 2166 adult family members of ICU patients in 37 UK hospitals. Most were grown up children (33%) or spouses/partners (23%). Most (91%) were ≤ 65 years. Mean (SD) pre-virtual-visit Distress Thermometer score was 7 (2.6) with 1349/2153 (62%) reporting severe distress. Pre-visit Distress Thermometer scores were associated with relationship type (spouse/partner OR 1.65, 95% CI 1.27–2.12) but not family member age, or length of ICU stay. Mean (SD) post-visit Distress Thermometer score provided by 762 (35%) participants was 1.6 (3.2) points lower than pre-visit (P < 0.001). Of participants experiencing multiple visits, 22% continued to report severe distress. Median (IQR) pre-visit DASS-21 score was 18 (2–42) (1754 participants). Severe-to-extremely severe depression, anxiety, or stress were reported by 249 (14%), 321 (18%), and 165 (9%) participants, respectively. Participants reported a range of emotions with reassurance being the most common, anger being the least. Conclusion Family members exposed to COVID-19 pandemic ICU visiting restrictions experienced severe distress. One fifth of family members reported severe-to-extremely sever anxiety or depression. Distress score magnitude and prevalence of severe distress decreased after undertaking one or more virtual visits.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, Rm 1.13, James Clerk Maxwell Building, 57 Waterloo Rd, London, SE1 8WA, UK.
| | - Amelia Cook
- Cicely Saunders Institute, King's College London, London, UK
| | - Juliana Onwumere
- Department of Psychology at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ella Terblanche
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, Rm 1.13, James Clerk Maxwell Building, 57 Waterloo Rd, London, SE1 8WA, UK
| | - Natalie Pattison
- University of Hertfordshire, Hertfordshire, UK
- East and North Herts NHS Trust, Stevenage, UK
| | | | - Joel Meyer
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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O'Gara G, Wiseman T, Doyle AM, Pattison N. Chronic illness and critical care-A qualitative exploration of family experience and need. Nurs Crit Care 2022. [PMID: 35833675 DOI: 10.1111/nicc.12817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with chronic illnesses such as cancer and cardiovascular disease are living longer and often require the support of critical care services. Current health care provision means patients may be discharged home once clinically stable despite still having high care demands including social, emotional, or physical needs. Families are often required to assume caregiving roles. Research into family burden using quantitative methods has increased awareness, however, little qualitative work exists and the development of support interventions for families is required. AIMS To explore the experience and needs of family members of people with an existing chronic illness who are admitted to the Critical Care Unit (CCU), and to identify the desired components of a family support intervention in the form of a resource toolkit. STUDY DESIGN A qualitative exploration of family experience and need, and content development for a resource toolkit using focus group methodology. Two focus groups and one face-to-face interview were conducted involving nine adult (≥18 years) family members of adult patients with chronic illness admitted to critical care in the preceding 9 months across two specialist hospitals in the UK. These were digitally recorded, transcribed, and thematically analysed. FINDINGS Four themes were identified: importance of communication, need for support, trauma of chronic illness, and having to provide "Do-it-Yourself" care. The immense responsibility of families to provide care throughout the illness trajectory is highlighted. Understandable information is essential for a family support toolkit. CONCLUSION Family members often view a critical care episode broadly from diagnosis through to recovery/rehabilitation. Basic communication training skills within critical care should be ensured, alongside coordination of simple solutions. The potential traumatic impact on families should be highlighted early within the pathway, and positive aspects used to harness essential family support. A simple and coordinated approach to a toolkit is preferred. RELEVANCE TO CLINICAL PRACTICE This study highlights that a critical care experience may impact broadly beyond CCU, and the importance of informing patients and families of this potential experience, prior to or on admission, to aid preparation. Further highlighted is the need for contemporaneous and accurate information from clinicians involved in care. Families report a better experience when there is good collaboration across critical care services and admitting clinical teams. Early involvement of families in overall discharge planning is essential to allow patients and families to adjust and plan for recovery.
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Affiliation(s)
- Geraldine O'Gara
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK
| | - Theresa Wiseman
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK
| | - Anne-Marie Doyle
- Department of Psychological Medicine, Royal Brompton Hospital, London, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire/East and North Herts NHS Trust, Hertfordshire, UK
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Vollam S, Gustafson O, Morgan L, Pattison N, Thomas H, Watkinson P. Patient Harm and Institutional Avoidability of Out-of-Hours Discharge From Intensive Care: An Analysis Using Mixed Methods. Crit Care Med 2022; 50:1083-1092. [PMID: 35245235 PMCID: PMC9197137 DOI: 10.1097/ccm.0000000000005514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Out-of-hours discharge from ICU to the ward is associated with increased in-hospital mortality and ICU readmission. Little is known about why this occurs. We map the discharge process and describe the consequences of out-of-hours discharge to inform practice changes to reduce the impact of discharge at night. DESIGN This study was part of the REcovery FoLlowing intensive CarE Treatment mixed methods study. We defined out-of-hours discharge as 16:00 to 07:59 hours. We undertook 20 in-depth case record reviews where in-hospital death after ICU discharge had been judged "probably avoidable" in previous retrospective structured judgment reviews, and 20 where patients survived. We conducted semistructured interviews with 55 patients, family members, and staff with experience of ICU discharge processes. These, along with a stakeholder focus group, informed ICU discharge process mapping using the human factors-based functional analysis resonance method. SETTING Three U.K. National Health Service hospitals, chosen to represent different hospital settings. SUBJECTS Patients discharged from ICU, their families, and staff involved in their care. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Out-of-hours discharge was common. Patients and staff described out-of-hours discharge as unsafe due to a reduction in staffing and skill mix at night. Patients discharged out-of-hours were commonly discharged prematurely, had inadequate handover, were physiologically unstable, and did not have deterioration recognized or escalated appropriately. We identified five interdependent function keys to facilitating timely ICU discharge: multidisciplinary team decision for discharge, patient prepared for discharge, bed meeting, bed manager allocation of beds, and ward bed made available. CONCLUSIONS We identified significant limitations in out-of-hours care provision following overnight discharge from ICU. Transfer to the ward before 16:00 should be facilitated where possible. Our work highlights changes to help make day time discharge more likely. Where discharge after 16:00 is unavoidable, support systems should be implemented to ensure the safety of patients discharged from ICU at night.
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Affiliation(s)
- Sarah Vollam
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Owen Gustafson
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Lauren Morgan
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
- East and North Herts NHS Trust, Stevenage, United Kingdom
| | - Hilary Thomas
- Centre for Research in Public Health and Community Care, School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Peter Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Rose L, Graham T, Xyrichis A, Pattison N, Metaxa V, Saha S, Ramsay P, Meyer J. Family perspectives on facilitators and barriers to the set up and conduct of virtual visiting in intensive care during the COVID-19 pandemic: a qualitative interview study. Intensive Crit Care Nurs 2022; 72:103264. [PMID: 35672211 PMCID: PMC9114263 DOI: 10.1016/j.iccn.2022.103264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 11/05/2022]
Abstract
Objective Methods Results Conclusion
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Xyrichis A, Pattison N, Ramsay P, Saha S, Cook A, Metaxa V, Meyer J, Rose L. Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members. BMJ Open 2022; 12:e055679. [PMID: 35487757 PMCID: PMC9058291 DOI: 10.1136/bmjopen-2021-055679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To understand the experiences and perceived benefits of virtual visiting from the perspectives of intensive care unit (ICU)-experienced clinicians and non-ICU-experienced family liaison team members. DESIGN Qualitative descriptive study. SETTING Adult intensive care setting across 14 hospitals within the UK National Health Service. PARTICIPANTS ICU-experienced clinicians and non-ICU-experienced family liaison team members deployed during the first wave of the COVID-19 pandemic. METHODS Semistructured telephone/video interviews were conducted with ICU clinicians. Analytical themes were developed inductively following a standard thematic approach, using 'family-centred care' and 'sensemaking' as sensitising concepts. RESULTS We completed 36 interviews, with 17 ICU-experienced clinicians and 19 non-ICU-experienced family liaison team members. In the context of inperson visiting restrictions, virtual visiting offered an alternative conduit to (1) restoring the family unit, (2) facilitating family involvement, and (3) enabling sensemaking for the family. Virtual visits with multiple family members concurrently and with those living in distant geographical locations restored a sense of family unit. Family involvement in rehabilitation, communication and orientation activities, as well as presence at the end of life, highlighted how virtual visiting could contribute to family-centred care. Virtual visits were emotionally challenging for many family members, but also cathartic in helping make sense of their own emotions and experience by visualising their relatives in the ICU. Being able to see and interact with loved ones and their immediate care providers afforded important cues to enable family sensemaking of the ICU experience. CONCLUSIONS In this UK qualitative study of clinicians using virtual ICU visiting, in the absence of inperson visiting, virtual visiting was perceived positively as an alternative that promoted family-centred care through virtual presence. We anticipate the perceived benefits of virtual visiting may extend to non-pandemic conditions through improved equity and timeliness of family access to the ICU by offering an alternative option alongside inperson visiting.
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Affiliation(s)
- Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, England, UK
| | | | - Pam Ramsay
- School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Sian Saha
- ACET Research Team, King's College Hospital, London, England, UK
| | - Amelia Cook
- Cicely Saunders Institute, King's College London, London, England, UK
| | | | - Joel Meyer
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, England, UK
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Endacott R, Pattison N, Dall'Ora C, Griffiths P, Richardson A, Pearce S. The organisation of nurse staffing in intensive care units: a qualitative study. J Nurs Manag 2022; 30:1283-1294. [PMID: 35343005 DOI: 10.1111/jonm.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022]
Abstract
AIMS To examine the organisation of the nursing workforce in intensive care units and identify factors that influence how the workforce operates. BACKGROUND Pre-pandemic UK survey data show that up to 60% of intensive care units did not meet locally agreed staffing numbers and 40% of ICUs were closing beds at least once a week because of workforce shortages, specifically nursing. Nurse staffing in intensive care is based on the assumption that sicker patients need more nursing resource than those recovering from critical illness. These standards are based on historical working, and expert professional consensus, deemed the weakest form of evidence. METHODS Focus groups with intensive care health care professionals (n= 52 participants) and individual interviews with critical care network leads and policy leads (n= 14 participants) in England between December 2019 and July 2020. Data were analysed using framework analysis. FINDINGS Three themes were identified: the constraining or enabling nature of intensive care and hospital structures; whole team processes to mitigate nurse staffing shortfalls; and the impact of nurse staffing on patient, staff and intensive care flow outcomes. Staff made decisions about staffing throughout a shift and were influenced by a combination of factors illuminated in the three themes. CONCLUSIONS Whilst nurse: patient ratios were clearly used to set the nursing establishment, it was clear that rostering and allocation/re-allocation during a shift took into account many other factors, such as patient and family nursing needs, staff wellbeing, intensive care layout and the experience, and availability, of other members of the multi-professional team. This has important implications for future planning for intensive care nurse staffing and highlights important factors to be accounted for in future research studies. IMPLICATIONS FOR NURSING MANAGEMENT In order to safeguard patient and staff safety, factors such as the ICU layout need to be considered in staffing decisions and the local business case for nurse staffing needs to reflect these factors. Patient safety in intensive care may not be best served by a blanket 'ratio' approach to nurse staffing, intended to apply uniformly across health services.
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Affiliation(s)
- Ruth Endacott
- School of Nursing & Midwifery, University of Plymouth, Plymouth.,School of Nursing & Midwifery, Monash University, Melbourne, Australia.,Current Institution/address: National Institute for Health Research, Minerva House, Montague Close, London
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield.,East and North Herts NHS Trust, Coreys Mill Lane, Stevenage
| | | | | | | | - Susie Pearce
- School of Nursing & Midwifery, University of Plymouth, Plymouth.,Clinical School, University of Plymouth/Torbay and South Devon NHS Foundation Trust
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24
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Sanderson EAM, Humphreys S, Walker F, Harris D, Carduff E, McPeake J, Boyd K, Pattison N, Lone NI. Risk factors for complicated grief among family members bereaved in intensive care unit settings: A systematic review. PLoS One 2022; 17:e0264971. [PMID: 35271633 PMCID: PMC8912194 DOI: 10.1371/journal.pone.0264971] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background Families of intensive care unit (ICU) decedents are at increased risk of experiencing complicated grief. However, factors associated with complicated grief in ICU and bereavement needs assessment are not available routinely. We aimed to conduct a systematic review identifying risk factors associated with complicated grief among family members of ICU decedents. Materials and methods MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and Web of Science were searched to identify relevant articles. Observational studies and randomised and non-randomised controlled trials were included. Studies were screened and quality appraised in duplicate. Risk of bias was assessed using Newcastle-Ottawa Scale. A narrative synthesis was undertaken. Results Seven studies conducted across three continents were eligible. Four studies were of high quality. 61 risk factors were investigated across the studies. Factors associated with a decreased risk of complicated grief included age, patient declining treatment and involvement in decision-making. Factors associated with increased risk included living alone, partner, dying while intubated, problematic communication, and not having the opportunity to say goodbye. Conclusion This systematic review has identified risk factors which may help identify family members at increased risk of complicated grief. Many of the studies has small sample sizes increasing the risk of erroneously reporting no effect due to type II error. Some factors are specific to the ICU setting and are potentially modifiable. Bereavement services tailored to the needs of bereaved family members in ICU settings are required. (PROSPERO registration ID 209503)
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Affiliation(s)
| | | | | | - Daniel Harris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Kirsty Boyd
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Natalie Pattison
- University of Hertfordshire, Hatfield, United Kingdom
- East and North Herts NHS Trust, Stevenage, Hertfordshire, United Kingdom
| | - Nazir I. Lone
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- NHS Lothian, Edinburgh, United Kingdom
- * E-mail:
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25
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Felton T, Pattison N, Fletcher S, Finney S, Walsh T, Dark P. Co-enrolment to UK Critical Care Studies - A 2019 update. J Intensive Care Soc 2022; 23:53-57. [PMID: 37593536 PMCID: PMC10427850 DOI: 10.1177/1751143720971542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
In 2013, a group of clinicians on behalf of the National Institute for Health Research, collaborated with ICU Steps to produce guidance about people being enrolled in more than one critical care trial. This is referred to as "co-enrolment" and can be where a person takes part in one study at the same time as another study (or one after the other in a short time-frame). For instance, being part of a study looking at sepsis drugs and a mechanical ventilation weaning study. The drivers for developing this guidance were a lack of any existing guidance, nationally and internationally, at that time, and a desire to ensure high quality research is conducted. The emphasis was on making trials as safe as possible for patients and ensuring robust trial outcomes. Critical care was seen to lead in this, with our exemplar guidance used across all health research. We wish to revisit this guidance now that there is more experience of coenrolment in critical care trials. There is also more awareness of different consent models, such as deferred consent (taking consent when a person is awake and able to give consent) and consultee consent (asking families or independent professionals to consent). Consenting to coenrolment is an important ethical consideration for the revision of this guidance.
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Affiliation(s)
- Timothy Felton
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Simon Fletcher
- Anaesthetics and Intensive Care, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Simon Finney
- Intensive Care and Anaesthesia, Barts Health NHS Trust, London, UK
| | - Tim Walsh
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
| | - Paul Dark
- Critical Care Unit, Salford Royal NHS Foundation Trust, Northern Care Alliance NHS Group, Greater Manchester, UK
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26
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Almomani E, Alinier G, Pattison N. Approaches that promote clinical reasoning in clinical and simulation-based practice settings. Journal of Emergency Medicine, Trauma and Acute Care 2022. [DOI: 10.5339/jemtac.2022.qhc.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Emad Almomani
- Department of Nursing, Midwifery, Education and Research, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Guillaume Alinier
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Weill Cornell Medicine-Qatar, Doha, Qatar
- Hamad Medical Corporation Ambulance Service, Doha, Qatar
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
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Dogan B, Pattison N, Alinier G. 144 Simulation Without the Bells and Whistles of Technology. Simul Healthc 2021. [DOI: 10.54531/pgvt4167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Full-scale simulation (FSS) is one of the most effective and commonly used simulation modalities in healthcare education. It enables the rehearsal of skills in a safe and controlled environment without the risk of harming patients, which provides a strong argument for it being a useful educational approach. With technological developments and the widescale use of simulation technologies in many institutions, simulation has become an essential part of healthcare professional training and curricula. However, setting up a simulation laboratory can be very costly for institutions, as can training facilitators and ensuring equipment maintenance. Simulated patients (actors) are also not universally embraced because of the costs. This makes running an FSS challenging. Furthermore, technology fear, shortage of trained staff, scarcity of space and equipment, workload and applicability to the existing curriculum can be acknowledged as further barriers to the adoption of FSS. We assert that Visually-Enhanced Mental Simulation (VEMS), which includes a patient poster instead of a patient simulator or simulated patient This study aimed to explore nursing students’ evaluation of the VEMS sessions.VEMS is a mental form of simulation which includes basic representations of a patient, equipment and interventions. A laminated patient poster is used to represent the patient and laminated equipment cards are used for equipment. A whiteboard or flipchart are used to write interventions and patient parameters in real-time. Also, the simulation session includes ‘thinking aloud’ (participants verbalize their thinking process and actions). Before the scenario, pre-briefing takes place, and a debriefing follows after the scenario, as in FSS.As part of a wider project, we piloted the use of VEMS with 30 final-year adult nursing students who consented to participate in VEMS sessions. The main study relied on a quasi-experimental design to compare two simulation modalities, FSS and VEMS. The study was approved by the University of Hertfordshire Ethics Committee (protocol number: aHSK/PGR/UH/03692(2)). Final-year adult nursing students studying at the university were targeted for this study. Control (FSS) and experimental (VEMS) groups were exposed to the same scenarios which included two deteriorating postoperative patients. Students were asked to evaluate the effectiveness of the simulation session with the Simulation Effectiveness Tool-Modified (SET-M) The students found VEMS to be effective for their learning and confidence as they marked it 43.70 (SD: 9.11) out of 57. The pre-briefing part scored 2.41 (SD: 0.61), the learning scored 2.19 (SD: 0.50), the confidence subscale scored 2.25 (SD: 0.57), and the debriefing part scored 2.51 (SD: 0.53), all out of three points.This may suggest that students found the VEMS session a useful learning activity which also contributed to developing their confidence. Based on the pilot study questionnaire data, it could be argued that VEMS can be a valuable simulation approach in nursing education as it does not rely on technology and is easy to facilitate anywhere.
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Almomani E, Alinier G, Pattison N, Samuel J. 132 Assessment Tools to Measure Clinical Reasoning While Attending Simulation-Based Courses. Simul Healthc 2021. [DOI: 10.54531/udzb8526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical reasoning is interconnected with decision-making which is a critical element to ensure patient safety A scoping review was undertaken to answer the questions: What are the best available valid and reliable tools to evaluate clinical reasoning while attending simulation-based activities? Do we have valid and reliable clinical reasoning assessment tools for simulation that measure clinical reasoning considering different seniority and competency levels? We searched Medline, Scopus, Education Research Complete, and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of: ‘Clinical reasoning’, ‘Simulation-based courses’ and ‘Clinical Reasoning tools’. The inclusion criteria were primary studies that described the use of tools measuring clinical reasoning while attending simulation-based courses. Two independent researchers agreed on the inclusion of the identified papers for full-text review. This review followed the review guidelines of Joanne Briggs institute.There are valid and reliable tools to evaluate clinical reasoning while attending simulation which is Clinical Reasoning Evaluation Simulation Tool CREST There is an adequate number of tools to measure clinical reasoning while attending simulation. However, there is a significant basis to test the reliability and validity of these tools against different competence and seniority levels, and applicability to other healthcare professions.
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Pattison N. An ever-thorny issue: Defining key elements of critical care nursing and its relation to staffing. Nurs Crit Care 2021; 26:421-424. [PMID: 34783138 DOI: 10.1111/nicc.12726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Natalie Pattison
- University of Hertfordshire, UK.,East & North Hertfordshire NHS Trust, UK
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30
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Endacott R, Pearce S, Rae P, Richardson A, Bench S, Pattison N. How COVID-19 has affected staffing models in intensive care: A qualitative study examining alternative staffing models (SEISMIC). J Adv Nurs 2021; 78:1075-1088. [PMID: 34779532 DOI: 10.1111/jan.15081] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
AIMS To understand how COVID-19 affected nurse staffing in intensive care units (ICUs) in England, and to identify factors that influenced, and were influenced by, pandemic staffing models. DESIGN Exploratory qualitative study. METHODS Semi-structured, online interviews conducted July-September 2020 with regional critical care leaders including policy leads (n = 4) and directors/lead nurses (n = 10) across critical care networks in England. FINDINGS The six themes emerging from the framework analysis illustrate how the pre-pandemic ICU culture influenced ICU staffing models during the pandemic. Changes in staffing impacted on the workforce and the care delivered, whilst it was necessary to learn from, and adjust to, a rapidly changing situation. Variation across and between networks necessitated variation in responses. The overwhelming outcome was that the pandemic has challenged the central tenets of ICU nurse staffing. CONCLUSIONS Pandemic nurse staffing models resulted in changes to ICU skill-mix and staffing numbers. Factors such as the impact of nurse staffing on care practices and on the workforce need to be taken into account when developing and testing future nurse staffing models for ICU. The extent to which ICUs will return to former staffing models is not yet known but there seems to be an appetite for change. IMPACT In common with many countries, nurse staffing in English ICUs was adapted to address surge requirements during the COVID-19 pandemic. Findings highlight the challenge COVID-19 presented to pre-pandemic ICU nurse staffing guidelines, the impact on patient and staff well-being and the potential legacy for future staffing models. Study findings have implications for ICU nurse managers, researchers and policy makers: nurse staffing models need to be adaptable to the local context of care and future research should investigate the impact of different models on patients, staff and health service outcomes.
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Affiliation(s)
- Ruth Endacott
- CRN National Coordinating Centre (CRNCC), National Institute for Health Research (NIHR), London, UK
| | - Susie Pearce
- School of Nursing & Midwifery, University of Plymouth, Plymouth, UK.,Clinical School, University of Plymouth/Torbay and South Devon NHS Foundation Trust, Plymouth, UK
| | - Pamela Rae
- School of Nursing & Midwifery, University of Plymouth, Plymouth, UK
| | - Annette Richardson
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Suzanne Bench
- London South Bank University, London, UK.,Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Natalie Pattison
- University of Hertfordshire, Hatfield, UK.,East and North Herts NHS Trust, Stevenage, UK
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31
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Rose L, Yu L, Casey J, Cook A, Metaxa V, Pattison N, Rafferty AM, Ramsay P, Saha S, Xyrichis A, Meyer J. Communication and Virtual Visiting for Families of Patients in Intensive Care during the COVID-19 Pandemic: A UK National Survey. Ann Am Thorac Soc 2021; 18:1685-1692. [PMID: 33617747 PMCID: PMC8522289 DOI: 10.1513/annalsats.202012-1500oc] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/19/2021] [Indexed: 12/21/2022] Open
Abstract
Rationale: Restriction or prohibition of family visiting intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic poses substantial barriers to communication and family- and patient-centered care. Objectives: To understand how communication among families, patients, and the ICU team was enabled during the pandemic. The secondary objectives were to understand strategies used to facilitate virtual visiting and associated benefits and barriers. Methods: A multicenter, cross-sectional, and self-administered electronic survey was sent (June 2020) to all 217 UK hospitals with at least one ICU. Results: The survey response rate was 54%; 117 of 217 hospitals (182 ICUs) responded. All hospitals imposed visiting restrictions, with visits not permitted under any circumstance in 16% of hospitals (28 ICUs); 63% (112 ICUs) of hospitals permitted family presence at the end of life. The responsibility for communicating with families shifted with decreased bedside nurse involvement. A dedicated ICU family-liaison team was established in 50% (106 ICUs) of hospitals. All but three hospitals instituted virtual visiting, although there was substantial heterogeneity in the videoconferencing platform used. Unconscious or sedated ICU patients were deemed ineligible for virtual visits in 23% of ICUs. Patients at the end of life were deemed ineligible for virtual visits in 7% of ICUs. Commonly reported benefits of virtual visiting were reducing patient psychological distress (78%), improving staff morale (68%), and reorientation of patients with delirium (47%). Common barriers to virtual visiting were related to insufficient staff time, rapid implementation of videoconferencing technology, and challenges associated with family members' ability to use videoconferencing technology or access a device. Conclusions: Virtual visiting and dedicated communication teams were common COVID-19 pandemic innovations addressing the restrictions to family ICU visiting, and they resulted in valuable benefits in terms of patient recovery and staff morale. Enhancing access and developing a more consistent approach to family virtual ICU visits could improve the quality of care, both during and outside of pandemic conditions.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, and
| | - Lisa Yu
- King’s Health Partners, London, United Kingdom
| | | | - Amelia Cook
- Cicely Saunders Institute, King’s College London, London,United Kingdom
| | | | - Natalie Pattison
- East and North Hertfordshire National Health Service Trust, Hertfordshire, United Kingdom
- University of Hertfordshire, Hertfordshire, United Kingdom
| | | | - Pam Ramsay
- University of Dundee, Dundee, United Kingdom; and
| | - Sian Saha
- King's College Hospital, London, United Kingdom
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, and
| | - Joel Meyer
- Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
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Godbold R, Whiting L, Adams C, Naidu Y, Pattison N. The experiences of student nurses in a pandemic: A qualitative study. Nurse Educ Pract 2021; 56:103186. [PMID: 34555786 PMCID: PMC8452386 DOI: 10.1016/j.nepr.2021.103186] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/04/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
Aim/objective To record and learn from the experiences of students working on clinical placement in a pandemic. Background In March of 2020, final and second year student nurses in England were given the option to join the Covid-19 pandemic work-force, paid as high-level health care assistants. Methods/design Using qualitative methods and rapid analysis techniques, this study gathered the unique experiences of 16 final year students, from all fields of nursing at a University in the East of England, who chose to complete their final extended placement in a diverse range of clinical placements at the height of the first wave of the pandemic. Data was collected between July and September 2020. Results Five key themes were identified across our data: rationale for undertaking the extended placement, role tensions, caring for patients and their families, the impact on teaching and learning, and personal health and wellbeing. Conclusions While our participants reported largely positive experiences including a perceived heightened preparedness for qualification, their experiences provide important insights for nurse educators for the education and support of future students going into similar situations, in particular relating to welfare and support, preparation for placement, resilience, e-learning and learning on the front line.
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Affiliation(s)
- Rosemary Godbold
- School of Health and Social Work, University of Hertfordshire College Lane, Hatfield, Hertfordshire AL10 9AB, United Kingdom.
| | - Lisa Whiting
- School of Health and Social Work, University of Hertfordshire College Lane, Hatfield, Hertfordshire AL10 9AB, United Kingdom.
| | - Claire Adams
- School of Health and Social Work, University of Hertfordshire College Lane, Hatfield, Hertfordshire AL10 9AB, United Kingdom.
| | - Yogini Naidu
- School of Health and Social Work, University of Hertfordshire College Lane, Hatfield, Hertfordshire AL10 9AB, United Kingdom.
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire College Lane, Hatfield, Hertfordshire AL10 9AB, United Kingdom.
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Mayes J, McLachlan S, Carduff E, McPeake J, Boyd KJ, Pattison N, Lone N. Deaths in critical care and hospice-prevalence, trends, influences: a national decedent cohort study. BMJ Support Palliat Care 2021:bmjspcare-2021-003157. [PMID: 34380665 DOI: 10.1136/bmjspcare-2021-003157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES End-of-life and bereavement care support services differ in critical care and inpatient hospice settings. There are limited population-level data comparing deaths in these two locations. We aimed to compare the characteristics of people who die in critical care units and in hospices, identify factors associated with place of death and report 12-year trends in Scotland. METHODS We undertook a cohort study of decedents aged ≥16 years in Scotland (2005-2017). Location of death was identified from linkage to the Scottish Intensive Care Society Audit Group database and National Records of Scotland Death Records. We developed a multinomial logistic regression model to identify factors independently associated with location of death. RESULTS There were 710 829 deaths in Scotland, of which 36 316 (5.1%) occurred in critical care units and 42 988 (6.1%) in hospices. As a proportion of acute hospital deaths, critical care deaths increased from 8.0% to 11.2%. Approximately one in eight deaths in those aged under 40 years occurred in critical care. Factors independently associated with hospice death included living in less deprived areas, cancer as the cause of death and presence of comorbidities. In contrast, liver disease and accidents as the cause of death and absence of comorbidities were associated with death in critical care. CONCLUSIONS Similar proportions of deaths in Scotland occur in critical care units and hospices. Given the younger age profile and unexpected nature of deaths occurring in critical care units, there is a need for a specific focus on end-of-life and bereavement support services in critical care units.
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Affiliation(s)
- Jonathan Mayes
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- NHS Lothian, Edinburgh, UK
| | | | | | - Joanne McPeake
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Kirsty J Boyd
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Nazir Lone
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- NHS Lothian, Edinburgh, UK
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Doğan B, Pattison N, Alinier G. An untested approach to facilitating visually enhanced mental simulation online with multiple learners: A mini guide. Journal of Emergency Medicine, Trauma and Acute Care 2021. [DOI: 10.5339/jemtac.2021.qhc.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Burcu Doğan
- School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, HERTS, AL10 9AB, United Kingdom E-mail:
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, HERTS, AL10 9AB, United Kingdom E-mail:
| | - Guillaume Alinier
- School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, HERTS, AL10 9AB, United Kingdom E-mail:
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
- Hamad Medical Corporation Ambulance Service, Doha, Qatar
- Weill Cornell Medicine – Qatar, Doha, Qatar
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Abstract
OBJECTIVE To understand National Health Service (NHS) staff experiences of working in critical care during the first wave of the COVID-19 pandemic in the UK. DESIGN Qualitative study using semistructured telephone interviews and rapid analysis, interpreted using Baehr's sociological lens of 'communities of fate'. PARTICIPANTS Forty NHS staff working in critical care, including 21 nurses, 10 doctors and advanced critical care practitioners, 4 allied health professionals, 3 operating department practitioners and 2 ward clerks. Participants were interviewed between August and October 2020; we purposefully sought the experiences of trained and experienced critical care staff and those who were redeployed. SETTING Four hospitals in the UK. RESULTS COVID-19 presented staff with a situation of extreme stress, duress and social emergency, leading to a shared set of experiences which we have characterised as a community of fate. This involved not only fear and dread of working in critical care, but also a collective sense of duty and vocation. Caring for patients and families involved changes to usual ways of working, revolving around: reorganisation of space and personnel, personal protective equipment, lack of evidence for treating COVID-19, inability for families to be physically present, and the trauma of witnessing extreme patient acuity and death on a large scale. The stress and isolation of working in critical care during COVID-19 was mitigated by strong teamwork, camaraderie, pride and fulfilment. CONCLUSION COVID-19 has changed working practices in critical care and profoundly affected staff physically, mentally and emotionally. Attention needs to be paid to the social and organisational conditions in which individuals work, addressing both practical resourcing and the interpersonal dynamics of critical care provision.
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Affiliation(s)
| | - Sally Humphreys
- Critical Care and Research & Development, West Suffolk NHS Foundation Trust, Suffolk, UK
| | | | - Annemarie B Docherty
- Anaesthetics, Theatres and Critical Care, NHS Lothian, Edinburgh, UK
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Steve Sturdy
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
- Science, Technology and Innovation Studies, University of Edinburgh, Edinburgh, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
- Nursing, East and North Hertfordshire NHS Trust, Stevenage, UK
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Pattison N, Deaton C, McCabe C, Coates V, Johnston B, Nolan F, Whiting L, Briggs M. Florence Nightingale's legacy for clinical academics: A framework analysis of a clinical professorial network and a model for clinical academia. J Clin Nurs 2021; 31:353-361. [PMID: 33797144 DOI: 10.1111/jocn.15756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical academic nursing roles are rare, and clinical academic leadership positions even more scarce. Amongst the United Kingdom (UK) academia, only 3% of nurses who are employed within universities are clinically active. Furthermore, access to research fellowships and research grant funding for nurses in clinical or academic practice is also limited. The work of Florence Nightingale, the original role model for clinical academic nursing, is discussed in terms of how this has shaped and influenced that of clinical academic nurse leaders in modern UK healthcare settings. We analysed case studies with a view to providing exemplars and informing a new model by which to visualise a trajectory of clinical academic careers. METHODS A Framework analysis of seven exemplar cases was conducted for a network of Clinical Academic Nursing Professors (n = 7), using a structured template. Independent analysis highlighted shared features of the roles: (a) model of clinical academic practice, (b) infrastructure for the post, (c) capacity-building initiatives, (d) strategic influence, (e) wider influence, (f) local and national implementation initiatives, (g) research area and focus and (h) impact and contribution. FINDINGS All seven of the professors of nursing involved in this discourse were based in both universities and healthcare organisations in an equal split. All had national and international profiles in their specialist clinical areas and were implementing innovation in their clinical and teaching settings through boundary spanning. We outline a model for career trajectories in clinical academia, and how leadership is crucial. CONCLUSION The model outlined emphasises the different stages of clinical academic roles in nursing. Nursing as a discipline needs to embrace the value of these roles, which have great potential to raise the standards of healthcare and the status of the profession.
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Affiliation(s)
- Natalie Pattison
- University of Hertfordshire, Hatfield, UK.,East/North Herts NHS Trust, Stevenage, UK
| | - Christi Deaton
- University of Cambridge, Cambridge, UK.,Cambridge University NHS Trust, Cambridge, UK
| | - Candy McCabe
- University of West England, Bristol, UK.,Dorothy House Hospice, Bath, UK
| | - Vivien Coates
- University of Ulster, Coleraine, UK.,Western Health and Social Care Trust, Londonderry, UK
| | - Bridget Johnston
- University of Glasgow, Glasgow, UK.,Glasgow Royal Infirmary, Glasgow, UK
| | | | | | - Michelle Briggs
- University of Manchester, Manchester, UK.,Manchester NHS Foundation Trust, Manchester, UK
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Allum L, Apps C, Hart N, Pattison N, Connolly B, Rose L. Standardising care in the ICU: a protocol for a scoping review of tools used to improve care delivery. Syst Rev 2020; 9:164. [PMID: 32682427 PMCID: PMC7368855 DOI: 10.1186/s13643-020-01414-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety; however, these tools have not been designed for the specific needs of patients with prolonged ICU stay. The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice. METHODS We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings. DISCUSSION The findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research. SYSTEMATIC REVIEW REGISTRATION This protocol is registered on the Open Science Framework, https://osf.io/ , DOI https://doi.org/10.17605/OSF.IO/Z8MRE.
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Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK. .,Lane Fox Clinical Respiratory Physiology Research Centre, London, UK.
| | - Chloe Apps
- Physiotherapy department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, UK.,Critical Care Research Group, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, London, UK.,National Institute for Health Research Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation and King's College London, London, UK
| | - Natalie Pattison
- University of Hertfordshire; East & North Herts NHS Trust; Florence Nightingale Foundation, London, UK
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, London, UK.,Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK.,Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, London, UK
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39
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Affiliation(s)
| | - Natalie Pattison
- University of Hertfordshire, School of Health and Social Work, London, UK
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40
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Affiliation(s)
- Natalie Pattison
- Florence Nightingale Foundation Clinical Professor of Nursing: University of Hertfordshire, East & North Herts NHS Trust, United Kingdom.
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Griffiths P, Saville C, Ball J, Culliford D, Pattison N, Monks T. Performance of the Safer Nursing Care Tool to measure nurse staffing requirements in acute hospitals: a multicentre observational study. BMJ Open 2020; 10:e035828. [PMID: 32414828 PMCID: PMC7232629 DOI: 10.1136/bmjopen-2019-035828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The best way to determine nurse staffing requirements on hospital wards is unclear. This study explores the precision of estimates of nurse staffing requirements made using the Safer Nursing Care Tool (SNCT) patient classification system for different sample sizes and investigates whether recommended staff levels correspond with professional judgements of adequate staffing. DESIGN Observational study linking datasets of staffing requirements (estimated using a tool) to professional judgements of adequate staffing. Multilevel logistic regression modelling. SETTING 81 medical/surgical units in four acute care hospitals. PARTICIPANTS 22 364 unit days where staffing levels and SNCT ratings were linked to nurse reports of "enough staff for quality". PRIMARY OUTCOME MEASURES SNCT-estimated staffing requirements and nurses' assessments of staffing adequacy. RESULTS The recommended minimum sample of 20 days allowed the required number to employ (the establishment) to be estimated with a mean precision (defined as half the width of the CI as a percentage of the mean) of 4.1%. For most units, much larger samples were required to estimate establishments within ±1 whole time equivalent staff member. When staffing was lower than that required according to the SNCT, for each hour per patient day of registered nurse staffing below the required staffing level, the odds of nurses reporting that there were enough staff to provide quality care were reduced by 11%. Correspondingly, the odds of nurses reporting that necessary nursing care was left undone were increased by 14%. No threshold indicating an optimal staffing level was observed. Surgical specialty, patient turnover and more single rooms were associated with lower odds of staffing adequacy. CONCLUSIONS The SNCT can provide reliable estimates of the number of nurses to employ on a unit, but larger samples than the recommended minimum are usually required. The SNCT provides a measure of nursing workload that correlates with professional judgements, but the recommended staffing levels may not be optimal. Some important sources of systematic variations in staffing requirements for some units are not accounted for. SNCT measurements are a potentially useful adjunct to professional judgement but cannot replace it. TRIAL REGISTRATION NUMBER ISRCTN12307968.
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Affiliation(s)
- Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, Hampshire, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, UK
| | - David Culliford
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, Hampshire, UK
| | - Natalie Pattison
- Department of Clinical Services, Royal Marsden NHS Foundation Trust, London, London, UK
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Thomas Monks
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, Hampshire, UK
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
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Griffiths P, Saville C, Ball JE, Chable R, Dimech A, Jones J, Jeffrey Y, Pattison N, Saucedo AR, Sinden N, Monks T. The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08160] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe Safer Nursing Care Tool is a system designed to guide decisions about nurse staffing requirements on hospital wards, in particular the number of nurses to employ (establishment). The Safer Nursing Care Tool is widely used in English hospitals but there is a lack of evidence about how effective and cost-effective nurse staffing tools are at providing the staffing levels needed for safe and quality patient care.ObjectivesTo determine whether or not the Safer Nursing Care Tool corresponds to professional judgement, to assess a range of options for using the Safer Nursing Care Tool and to model the costs and consequences of various ward staffing policies based on Safer Nursing Care Tool acuity/dependency measure.DesignThis was an observational study on medical/surgical wards in four NHS hospital trusts using regression, computer simulations and economic modelling. We compared the effects and costs of a ‘high’ establishment (set to meet demand on 90% of days), the ‘standard’ (mean-based) establishment and a ‘flexible (low)’ establishment (80% of the mean) providing a core staff group that would be sufficient on days of low demand, with flexible staff re-deployed/hired to meet fluctuations in demand.SettingMedical/surgical wards in four NHS hospital trusts.Main outcome measuresThe main outcome measures were professional judgement of staffing adequacy and reports of omissions in care, shifts staffed more than 15% below the measured requirement, cost per patient-day and cost per life saved.Data sourcesThe data sources were hospital administrative systems, staff reports and national reference costs.ResultsIn total, 81 wards participated (85% response rate), with data linking Safer Nursing Care Tool ratings and staffing levels for 26,362 wards × days (96% response rate). According to Safer Nursing Care Tool measures, 26% of all ward-days were understaffed by ≥ 15%. Nurses reported that they had enough staff to provide quality care on 78% of shifts. When using the Safer Nursing Care Tool to set establishments, on average 60 days of observation would be needed for a 95% confidence interval spanning 1 whole-time equivalent either side of the mean. Staffing levels below the daily requirement estimated using the Safer Nursing Care Tool were associated with lower odds of nurses reporting ‘enough staff for quality’ and more reports of missed nursing care. However, the relationship was effectively linear, with staffing above the recommended level associated with further improvements. In simulation experiments, ‘flexible (low)’ establishments led to high rates of understaffing and adverse outcomes, even when temporary staff were readily available. Cost savings were small when high temporary staff availability was assumed. ‘High’ establishments were associated with substantial reductions in understaffing and improved outcomes but higher costs, although, under most assumptions, the cost per life saved was considerably less than £30,000.LimitationsThis was an observational study. Outcomes of staffing establishments are simulated.ConclusionsUnderstanding the effect on wards of variability of workload is important when planning staffing levels. The Safer Nursing Care Tool correlates with professional judgement but does not identify optimal staffing levels. Employing more permanent staff than recommended by the Safer Nursing Care Tool guidelines, meeting demand most days, could be cost-effective. Apparent cost savings from ‘flexible (low)’ establishments are achieved largely by below-adequate staffing. Cost savings are eroded under the conditions of high temporary staff availability that are required to make such policies function.Future workResearch is needed to identify cut-off points for required staffing. Prospective studies measuring patient outcomes and comparing the results of different systems are feasible.Trial registrationCurrent Controlled Trials ISRCTN12307968.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane E Ball
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Rosemary Chable
- Training, Development & Workforce, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Dimech
- Clinical Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Yvonne Jeffrey
- Nursing & Patient Services, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Natalie Pattison
- Clinical Services, The Royal Marsden NHS Foundation Trust, London, UK
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | | | - Nicola Sinden
- Nursing Directorate, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Thomas Monks
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
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Pattison N, Arulkumaran N, O'Gara G, Connolly B, Humphreys S, Walsh T, Hopkins P, Dark P. Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure. BMJ Open 2019; 9:e030815. [PMID: 31871255 PMCID: PMC6937020 DOI: 10.1136/bmjopen-2019-030815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Conducting clinical trials in critical care is integral to improving patient care. Unique practical and ethical considerations exist in this patient population that make patient recruitment challenging, including narrow recruitment timeframes and obtaining patient consent often in time-critical situations. Units currently vary significantly in their ability to recruit according to infrastructure and level of research activity. AIM To identify variability in the research infrastructure of UK intensive care units and their ability to conduct research and recruit patients into clinical trials. DESIGN We evaluated factors related to intensive care patient enrolment into clinical trials in the UK. This consisted of a qualitative synthesis carried out with two datasets of in-depth interviews (distinct participants across the two datasets) conducted with 27 intensive care consultants (n=9), research nurses (n=17) and trial coordinators (n=1) from 27 units across the UK. Primary and secondary analyses of two datasets (one dataset had been analysed previously) were undertaken in the thematic analysis. FINDINGS The synthesis yielded an overarching core theme of normalising research, characterised by motivations for promoting research and fostering research-active cultures within resource constraints, with six themes under this to explain the factors influencing critical care research capacity: organisational, human, study, practical resources, clinician and patient/family factors. There was a strong sense of integrating research in routine clinical practice, and recommendations are outlined. CONCLUSIONS The central and transferable tenet of normalising research advocates the importance of developing a culture where research is inclusive alongside clinical practice in routine patient care and is a requisite for all healthcare individuals from organisational to direct patient contact level.
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Affiliation(s)
- Natalie Pattison
- School of Health and Social Work, University of Hertfordshire and East & North Hertfordshire NHS Trust, Hertfordshire, UK
- East and North Herts NHS Foundation Trust, Hertfordshire, United Kingdom
| | | | | | | | - Sally Humphreys
- Critical Care, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, UK
| | - Tim Walsh
- Critical Care, University of Edinburgh Royal Infirmary Edinburgh, Edinburgh, UK
| | | | - Paul Dark
- Intensive Care Unit, University of Manchester, Salford, Greater Manchester, UK
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Griffiths P, Saville C, Ball J, Jones J, Pattison N, Monks T. Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. Int J Nurs Stud 2019; 103:103487. [PMID: 31884330 PMCID: PMC7086229 DOI: 10.1016/j.ijnurstu.2019.103487] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/10/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
Background The importance of nurse staffing levels in acute hospital wards is widely recognised but evidence for tools to determine staffing requirements although extensive, has been reported to be weak. Building on a review of reviews undertaken in 2014, we set out to give an overview of the major approaches to assessing nurse staffing requirements and identify recent evidence in order to address unanswered questions including the accuracy and effectiveness of tools. Methods We undertook a systematic scoping review. Searches of Medline, the Cochrane Library and CINAHL were used to identify recent primary research, which was reviewed in the context of conclusions from existing reviews. Results The published literature is extensive and describes a variety of uses for tools including establishment setting, daily deployment and retrospective review. There are a variety of approaches including professional judgement, simple volume-based methods (such as patient-to-nurse ratios), patient prototype/classification and timed-task approaches. Tools generally attempt to match staffing to a mean average demand or time requirement despite evidence of skewed demand distributions. The largest group of recent studies reported the evaluation of (mainly new) tools and systems, but provides little evidence of impacts on patient care and none on costs. Benefits of staffing levels set using the tools appear to be linked to increased staffing with no evidence of tools providing a more efficient or effective use of a given staff resource. Although there is evidence that staffing assessments made using tools may correlate with other assessments, different systems lead to dramatically different estimates of staffing requirements. While it is evident that there are many sources of variation in demand, the extent to which systems can deliver staffing levels to meet such demand is unclear. The assumption that staffing to meet average need is the optimal response to varying demand is untested and may be incorrect. Conclusions Despite the importance of the question and the large volume of publication evidence about nurse staffing methods remains highly limited. There is no evidence to support the choice of any particular tool. Future research should focus on learning more about the use of existing tools rather than simply developing new ones. Priority research questions include how best to use tools to identify the required staffing level to meet varying patient need and the costs and consequences of using tools. Tweetable abstract Decades of research on tools to determine nurse staffing requirements is largely uninformative. Little is known about the costs or consequences of widely used tools.
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Affiliation(s)
- Peter Griffiths
- University of Southampton, Health Sciences, United Kingdom; National Institute for Health Research Applied Research Collaboration (Wessex), United Kingdom; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
| | - Christina Saville
- University of Southampton, Health Sciences, United Kingdom; National Institute for Health Research Applied Research Collaboration (Wessex), United Kingdom
| | - Jane Ball
- University of Southampton, Health Sciences, United Kingdom; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Jeremy Jones
- University of Southampton, Health Sciences, United Kingdom
| | - Natalie Pattison
- University of Hertfordshire, School of Health and Social Work, United Kingdom; East & North Hertfordshire NHS Trust, United Kingdom
| | - Thomas Monks
- University of Exeter, College of Medicine and Health, United Kingdom; National Institute for Health Research Applied Research Collaboration (Wessex), United Kingdom
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Affiliation(s)
- Natalie Pattison
- Senior Clinical Nursing Research Fellow/Trust lead for Patient Public Involvement in Research
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- Dovehouse DB3 Fulham Road SW36JJ, CCOT offices, Downs Rd, London SM25PT, UK
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Pattison N, Droney J, Gruber P. Burnout: Caring for critically ill and end‐of‐life patients with cancer. Nurs Crit Care 2019; 25:93-101. [DOI: 10.1111/nicc.12460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/13/2019] [Accepted: 06/06/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Natalie Pattison
- School of Health and Social Work, University of Hertfordshire Hatfield UK
- Nursing, East and North Herts NHS Trust Stevenage UK
- Critical Care, The Royal Marsden NHS FT London UK
| | - Joanne Droney
- Palliative Care UnitThe Royal Marsden NHS FT London UK
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O'Reilly A, Hughes P, Mann J, Lai Z, Teh JJ, Mclean E, Edmonds K, Lingard K, Chauhan D, Lynch J, Au L, Ludlow A, Pattison N, Wiseman T, Turajlic S, Gore M, Larkin J, Husson O. An immunotherapy survivor population: health-related quality of life and toxicity in patients with metastatic melanoma treated with immune checkpoint inhibitors. Support Care Cancer 2019; 28:561-570. [PMID: 31089820 PMCID: PMC6954131 DOI: 10.1007/s00520-019-04818-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/16/2019] [Indexed: 02/08/2023]
Abstract
Purpose The immune checkpoint inhibitors (ICIs) have resulted in subgroups of patients with metastatic melanoma achieving high-quality durable responses. Metastatic melanoma survivors are a new population in the era of cancer survivorship. The aim of this study was to evaluate metastatic melanoma survivors in terms of health-related quality of life (HRQoL), immune-related adverse events (irAEs) and exposure to immunosuppressive agents in a large single centre in the UK. Methods We defined the survivor population as patients with a diagnosis of metastatic melanoma who achieved a durable response to an ICI and had been followed-up for a minimum of 12 months from initiation of ICI without disease progression. HRQoL was assessed using SF-36. Electronic health records were accessed to collect data on demographics, treatments, irAEs and survival. HRQoL data was compared with two norm-based datasets. Results Eighty-four metastatic melanoma survivors were eligible and 87% (N = 73) completed the SF-36. ICI-related toxicity of any grade occurred in 92% of patients and 43% had experienced a grade 3 or 4 toxicity. Almost half (49%) of the patients required steroids for the treatment of ICI-related toxicity, whilst 14% required treatment with an immunosuppressive agent beyond steroids. Melanoma survivors had statistically significant lower HRQoL scores with regard to physical, social and physical role functioning and general health compared with the normative population. There was a trend towards inferior scores in patients with previous exposure to ipilimumab compared with those never exposed to ipilimumab. Conclusions Our results show that metastatic melanoma survivors have potentially experienced significant ICI-related toxicity and experience significant impairments in specific HRQoL domains. Future service planning is required to meet this population’s unique survivorship needs. Electronic supplementary material The online version of this article (10.1007/s00520-019-04818-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aine O'Reilly
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Peta Hughes
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Jasmine Mann
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | | | | | | | - Kim Edmonds
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Karla Lingard
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Dharmisha Chauhan
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Joanna Lynch
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Lewis Au
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Aileen Ludlow
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Natalie Pattison
- University of Hertfordshire/East & North Herts NHS Trust, London, UK
| | - Theresa Wiseman
- Health Service Research, Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Samra Turajlic
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK.,Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Martin Gore
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - James Larkin
- Renal and Skin Units, The Royal Marsden Hospital National Health Service Foundation Trust, London, UK
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research, London, UK.
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Pattison N, Duijts S. The value of systematic, rigorous and contemporary literature reviews in advancing cancer care. Eur J Cancer Care (Engl) 2019; 28:e13098. [DOI: 10.1111/ecc.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Natalie Pattison
- Florence Nightingale Foundation Clinical Professor of Nursing University of Hertfordshire/East and North Herts NHS Trust Hertfordshire UK
| | - Saskia Duijts
- Head Oncology in Primary Care/Senior Researcher Psycho Oncology University Medical Center Groningen/Amsterdam UMC Groningen The Netherlands
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Vollam S, Gustafson O, Hinton L, Morgan L, Pattison N, Thomas H, Young JD, Watkinson P. Protocol for a mixed-methods exploratory investigation of care following intensive care discharge: the REFLECT study. BMJ Open 2019; 9:e027838. [PMID: 30813113 PMCID: PMC6347880 DOI: 10.1136/bmjopen-2018-027838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION A substantial number of patients discharged from intensive care units (ICUs) subsequently die without leaving hospital. It is unclear how many of these deaths are preventable. Ward-based management following discharge from ICU is an area that patients and healthcare staff are concerned about. The primary aim of REFLECT (Recovery Following Intensive Care Treatment) is to develop an intervention plan to reduce in-hospital mortality rates in patients who have been discharged from ICU. METHODS AND ANALYSIS REFLECT is a multicentre mixed-methods exploratory study examining ward care delivery to adult patients discharged from ICU. The study will be made up of four substudies. Medical notes of patients who were discharged from ICU and subsequently died will be examined using a retrospective case records review (RCRR) technique. Patients and their relatives will be interviewed about their post-ICU care, including relatives of patients who died in hospital following ICU discharge. Staff involved in the care of patients post-ICU discharge will be interviewed about the care of this patient group. The medical records of patients who survived their post-ICU stay will also be reviewed using the RCRR technique. The analyses of the substudies will be both descriptive and use a modified grounded theory approach to identify emerging themes. The evidence generated in these four substudies will form the basis of the intervention development, which will take place through stakeholder and clinical expert meetings. ETHICS AND DISSEMINATION Ethical approval has been obtained through the Wales Research and Ethics Committee 4 (17/WA/0107). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER ISRCTN14658054.
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Affiliation(s)
- Sarah Vollam
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Owen Gustafson
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lisa Hinton
- Nuffield Department of Primary Health Care, University of Oxford, Oxford, UK
| | - Lauren Morgan
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Hilary Thomas
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - J Duncan Young
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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50
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Barth C, Soares M, Toffart AC, Timsit JF, Burghi G, Irrazabal C, Pattison N, Tobar E, Almeida BF, Silva UV, Azevedo LC, Rabbat A, Lamer C, Parrot A, Souza-Dantas VC, Wallet F, Blot F, Bourdin G, Piras C, Delemazure J, Durand M, Salluh J, Azoulay E, Lemiale V. Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs). Ann Intensive Care 2018; 8:80. [PMID: 30076547 PMCID: PMC6076209 DOI: 10.1186/s13613-018-0426-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. Methods A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013. Results Out of the 100 patients, 30 had small cell lung cancer (SCLC) and 70 had non-small cell lung cancer. (Thirty patients had already been treated with oncologic treatments.) Mechanical ventilation (MV) was performed for 81 patients. Seventeen patients received emergency chemotherapy during their ICU stay. ICU, hospital, 3- and 6-month mortality were, respectively, 47, 60, 67 and 71%. Hospital mortality was 60% when invasive MV was used alone, 71% when MV and vasopressors were needed and 83% when MV, vasopressors and hemodialysis were required. In multivariate analysis, hospital mortality was associated with metastatic disease (OR 4.22 [1.4–12.4]; p = 0.008), need for invasive MV (OR 4.20 [1.11–16.2]; p = 0.030), while chemotherapy in ICU was associated with survival (OR 0.23, [0.07–0.81]; p = 0.020). Conclusion This study shows that ICU management can be appropriate for selected newly diagnosed patients with advanced lung cancer, and chemotherapy might improve outcome for patients with SCLC admitted for cancer-related complications. Nevertheless, tumors’ characteristics, numbers and types of organ dysfunction should be taken into account in the decisional process before admitting these patients in ICU.
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Affiliation(s)
- C Barth
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - M Soares
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - A C Toffart
- Inserm, u 823, Institut A Bonniot, Grenoble, France
| | - J F Timsit
- Medical ICU, Hôpital Bichat-Claude Bernard, Paris, France
| | - G Burghi
- ICU, Hospital Maciel, Montevideo, Uruguay
| | - C Irrazabal
- ICU, Instituto Medico Especializado Alexander Fleming, Buenos Aires, Argentina
| | - N Pattison
- ICU, Royal Brompton NHS Foundation Trust, London ICU, Royal Marsden Hospital, London, UK
| | - E Tobar
- ICU, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - B F Almeida
- ICU, Hospital A. C. Camargo, São Paulo, Brazil
| | - U V Silva
- ICU, Fundação Pio XII-Hospital do Câncer de Barretos, Barretos, Brazil
| | - L C Azevedo
- ICU, Hospital Sírio Libanês, São Paulo, Brazil
| | - A Rabbat
- Thoracic ICU, Hôpital Cochin, Paris, France
| | - C Lamer
- ICU, Institut Mutualiste Montsouris, Paris, France
| | - A Parrot
- Medical ICU, Hôpital Tenon, Paris, France
| | - V C Souza-Dantas
- ICU, Instituto Nacional de Câncer-Hospital do Câncer I, Rio de Janeiro, Brazil
| | - F Wallet
- Medical-Surgical ICU, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France
| | - F Blot
- ICU, Institut Gustave Roussy, Villejuif, France
| | - G Bourdin
- Medical ICU, Hôpital de la Croix-Rousse, Lyon, France
| | - C Piras
- ICU, Vitória Apart Hospital, Vitória, Brazil
| | - J Delemazure
- Medical ICU, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - M Durand
- Surgical ICU, Hôpital A. Michallon Chu de Grenoble, Grenoble, France
| | - J Salluh
- Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - E Azoulay
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Virginie Lemiale
- Medical ICU, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
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