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Dijkstra BM, Rood PJT, Teerenstra S, Rutten AMF, Leerentveld C, Burgers-Bonthuis DC, Festen-Spanjer B, Klarenbeek T, Van Den Boogaard M, Ewalds E, Schoonhoven L, Van Der Hoeven JG, Vloet LCM. Effect of a Standardized Family Participation Program in the ICU: A Multicenter Stepped-Wedge Cluster Randomized Controlled Trial. Crit Care Med 2024; 52:420-431. [PMID: 37934138 PMCID: PMC10876177 DOI: 10.1097/ccm.0000000000006093] [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] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To determine the effect of a standardized program for family participation in essential care activities in the ICU on symptoms of anxiety, depression, posttraumatic stress and satisfaction among relatives, and perceptions and experiences of ICU healthcare providers (HCPs). DESIGN Multicenter stepped-wedge cluster randomized controlled trial. SETTING Seven adult ICUs, one university, and six general teaching hospitals. PARTICIPANTS Three hundred six relatives and 235 ICU HCPs. INTERVENTIONS A standardized program to facilitate family participation inpatient communication, amusement/distraction, comfort, personal care, breathing, mobilization, and nutrition. MEASUREMENTS AND MAIN RESULTS Data were collected through surveys among relatives and ICU HCPs. There were no significant differences in symptoms of anxiety in relatives in the intervention period compared with the control period (median Hospital Anxiety and Depression Scale [HADS] 5 [interquartile range (IQR) 2-10] vs 6 [IQR 3-9]; median ratio [MR] 0.72; 95% CI, 0.46-1.13; p = 0.15), depression (median HADS 4 [IQR 2-6] vs 3 [IQR 1-6]; MR 0.85; 95% CI, 0.55-1.32; p = 0.47) or posttraumatic stress (median Impact of Event Scale-Revised score 0.45 [IQR 0.27-0.82] vs 0.41 [IQR 0.14-1]; MR 0.94; 95% CI, 0.78-1.14; p = 0.54). Reported satisfaction was slightly lower in the intervention period (mean 8.90 [ sd 1.10] vs mean 9.06 [ sd 1.10], difference -0.60; 95% CI, -1.07 to -0.12; p = 0.01). ICU HCPs perceived that more relatives knew how to participate: 47% in the intervention period versus 22% in the control period (odds ratio [OR] 3.15; 95% CI, 1.64-6.05; p < 0.01). They also reported relatives having sufficient knowledge (41% vs 16%; OR 3.56; 95% CI, 1.75-7.25; p < 0.01) and skills (44% vs 25%; OR 2.38; 95% CI, 1.22-4.63; p = 0.01) to apply family participation. CONCLUSIONS Application of a standardized program to facilitate family participation did not change mental health symptoms in relatives of ICU patients 3 months after discharge. ICU HCPs reported increased clarity, knowledge, and skills among relatives and ICU HCPs.
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Affiliation(s)
- Boukje M Dijkstra
- Research Department Emergency and Critical Care, School of Health Studies Nijmegen, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul J T Rood
- Research Department Emergency and Critical Care, School of Health Studies Nijmegen, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne M F Rutten
- Department of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Crista Leerentveld
- Department of Intensive Care Medicine, ISALA Hospital, Zwolle, The Netherlands
| | | | | | - Toine Klarenbeek
- Department of Intensive Care Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Mark Van Den Boogaard
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther Ewalds
- Department of Intensive Care Medicine, Bernhoven, Uden, The Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | | | - Lilian C M Vloet
- Research Department Emergency and Critical Care, School of Health Studies Nijmegen, HAN University of Applied Sciences, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Foundation for Family and Patient Centered Intensive Care, Alkmaar, The Netherlands
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Dijkstra B, Uit Het Broek L, van der Hoeven J, Schoonhoven L, Bosch F, Van der Steen M, Rood P, Vloet L. Feasibility of a standardized family participation programme in the intensive care unit: A pilot survey study. Nurs Open 2023; 10:3596-3602. [PMID: 36617388 PMCID: PMC10170932 DOI: 10.1002/nop2.1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
AIM To assess the feasibility and applicability of a standardized programme to facilitate family participation in essential care activities in the intensive care unit. DESIGN Pilot study with a cross-sectional survey design. METHODS A standardized programme to facilitate family participation in essential nursing care activities was implemented in intensive care units of three hospitals in the Netherlands from November 2018 until March 2019. The feasibility and applicability of the programme were assessed with surveys of the patients, relatives and healthcare providers. RESULTS Three intensive care units successfully implemented the standardized programme. Three patients, ten relatives and 37 healthcare providers responded to the surveys. Patients appreciated family participation and recognized that their relatives liked to participate. Relatives appreciated being able to do something for the patient (80%) and to participate in essential care activities (60%). The majority of relatives (60%) felt they had sufficient knowledge and skills to participate and did not feel obliged nor uncomfortable. Healthcare providers felt they were trained adequately and motivated to apply family participation; application was perceived as easy, clear and relatively effortless according to the majority. According to 68% of the healthcare providers, most relatives were perceived to be capable of learning to participate in essential care activities. Some healthcare providers felt uncertain about the patient's wishes regarding family participation, with some indicating the behaviours of relatives and patients discouraged them from offering family participation. Use of a standardized programme to facilitate family participation in essential care activities in the intensive care unit seems feasible and applicable as determined by relatives and healthcare providers.
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Affiliation(s)
- Boukje Dijkstra
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.,Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lucia Uit Het Broek
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.,Acute Care Unit, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Frank Bosch
- Department of Intensive Care, Rijnstate, Arnhem, The Netherlands.,Section Acute Internal Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marijke Van der Steen
- Department of Intensive Care, Maasziekenhuis Pantein, Boxmeer, The Netherlands.,Department of Intensive Care, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Paul Rood
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.,Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lilian Vloet
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.,IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Foundation Family and Patient Centered Intensive Care, Alkmaar, The Netherlands
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Ten Cate D, Schoonhoven L, Huisman-de Waal G, Schuurmans MJ, Ettema RGA. Hospital and home care nurses' experiences and perceptions regarding nutritional care for older adults to prevent and treat malnutrition: A cross-sectional study. J Clin Nurs 2021; 30:2079-2092. [PMID: 33829601 DOI: 10.1111/jocn.15764] [Citation(s) in RCA: 6] [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: 10/22/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To gain insight into the experiences and perceptions of hospital and home care nurses regarding nutritional care for older adults to prevent and treat malnutrition. BACKGROUND In-depth knowledge about hospital and home care nurses' experiences and perceptions can contribute to optimise nutritional care for older adults across the care continuum between hospital and home to prevent and treat malnutrition. DESIGN Multicentre cross-sectional descriptive study. METHOD A validated questionnaire addressing malnutrition was used. A total of 1,135 questionnaires were sent to hospital and home care nurses. The STROBE statement was followed for reporting. RESULTS The response rate was 49% (n = 556). Of all the nurses, 37% perceived the prevalence of malnutrition among their care recipients between 10% and 25%. Almost 22% of the nurses neither agreed nor disagreed or disagreed with the statement that prevention of malnutrition is possible. More than 28% of the nurses reported that malnutrition is a small or no problem. Over 95% of the hospital nurses and 52.5% of the home care nurses stated they screened routinely for malnutrition. The nurses considered several interventions for treating malnutrition important. Over 81% of the nurses indicated they wanted to follow further training. CONCLUSION Most hospital and home care nurses perceived that nutritional care for older adults to prevent and treat malnutrition was important. A fair group of nurses, however, had the opposite perception. RELEVANCE TO CLINICAL PRACTICE Raising the awareness of all hospital and home care nurses about the importance of nutritional care for older adults is pivotal to increase the chance of successfully providing nursing nutritional care. Nurses should follow training for consolidation of nutritional care. Nurses are well-positioned to take a leadership role to improve continuity and quality of nutritional care across the care continuum between hospital and home.
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Affiliation(s)
- Debbie Ten Cate
- Research Group Chronic Diseases, Utrecht University of Applied Sciences, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Getty Huisman-de Waal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roelof G A Ettema
- Research Group Chronic Diseases, Utrecht University of Applied Sciences, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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O'Reilly P, O'Brien B, Graham MM, Murphy J, Barry L, Doody O, Fahy A, Hoey C, Kiely M, Lang D, Meskell P, O'Doherty J, O'Keefe J, Tuohy D, Coffey A. Key stakeholders' perspectives on the development of a national transfer document, for older persons, when transferring between the residential and acute care settings: A qualitative descriptive study. Int J Older People Nurs 2019; 14:e12254. [PMID: 31347762 DOI: 10.1111/opn.12254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/30/2019] [Revised: 03/13/2019] [Accepted: 06/04/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study has aimed to examine key stakeholders' perspectives, views and experiences regarding transfer documents, used when an older person is being transferred from a residential to an acute care setting. The objective of the study was to inform, in part, the development of an effective national transfer document. BACKGROUND For the effective and safe transfer of older persons from residential to acute care settings, it is important to ensure that the transfer document encapsulates relevant, current and person-centred information to ensure a smooth, quality and safe transition. Evidence highlights that, where documentation has lacked vital and relevant information, the older persons experience negative impacts during the transfer process. DESIGN A qualitative descriptive study was conducted, following the COREQ checklist, to establish participants' perspectives, views and experiences of using transfer documents. METHODS Focus group interviews (n = 8) were conducted with a convenience sample of key stakeholders (n = 68) in an Irish setting. The data were analysed using content analysis. RESULTS The findings have highlighted the important aspects for consideration in the development of future transfer documentation. The three broad categories, used to present the data findings, are (a) existing transfer documentation; (b) design framework; and (c) essentials of care. CONCLUSIONS The transfer document of the future is required to be concise, regularly reviewed and with a user-friendly colour-coded design. Essential and current information, with an emphasis on person centeredness, must be in the first page, with more detailed supporting information in the subsequent sections.
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Affiliation(s)
- Pauline O'Reilly
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Brid O'Brien
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Margaret M Graham
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Jill Murphy
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Louise Barry
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Owen Doody
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Anne Fahy
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Carmel Hoey
- Nursing and Midwifery Planning and Development Unit, HSE West/Mid-West, Galway, Ireland.,School of Nursing & Midwifery, National University of Ireland, Galway, Ireland
| | | | - Deirdre Lang
- HSE Clinical Strategy and Programmes Division, The Royal College of Physicians of Ireland, Dublin, Ireland
| | - Pauline Meskell
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Jane O'Doherty
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | | | - Dympna Tuohy
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Alice Coffey
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
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