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Collier A, Balmer D, Gilder E, Parke R. Patient safety and hospital visiting at the end of life during COVID-19 restrictions in Aotearoa New Zealand: a qualitative study. BMJ Qual Saf 2023; 32:704-711. [PMID: 36788035 DOI: 10.1136/bmjqs-2022-015471] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/18/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Visiting restrictions were enacted in Aotearoa New Zealand to reduce transmission of COVID-19 and protect the healthcare system. This research aimed to investigate the experiences of families and clinicians of hospital visiting for people with palliative and end-of-life care needs during restrictions. METHODS Semistructured interviews were completed between March and October 2021 with family members and clinicians who had personally experienced enactment of visiting restrictions during pandemic restrictions. A critical realist ontology was used to approach data analysis, sorting and coding to generate themes. RESULTS Twenty-seven participants were interviewed, 13 being families who had experienced bereavement of a family member during the restrictions: seven nurses or physicians and seven being non-bereaved family members. Four themes were generated: patient safety-(re)defining the 'Visitor'; the primacy of SARS-CoV-2-patient safety and negotiating risk; dying alone: enduring harms; and agency, strategies and workarounds. CONCLUSION Visitor rights and visitor policy at the end of life require greater protection during a pandemic. Transparent, coherent, publicly available evidence-based guidelines that key stakeholders, including patients, families and ethicists, are included in producing, are urgently required. We want to avert a legacy of disenfranchised grief in future pandemics.
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Affiliation(s)
- Aileen Collier
- Research Centre for Palliative Care Death and Dying (RePaDD), Flinders University, Adelaide, South Australia, Australia
| | - Deborah Balmer
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Eileen Gilder
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Rachael Parke
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
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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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Golomski C. Visiting Hours: Spacetimes of Human-Animal Interaction in South African Elder Care. Med Anthropol Q 2022; 36:217-236. [PMID: 35338789 DOI: 10.1111/maq.12702] [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: 11/26/2022]
Abstract
This article examines human-animal interaction in elder care by focusing on an old age home in postapartheid South Africa. Residents admire and desire to be near animals, but staff mostly prohibit pets and service animals due to regulations about hygiene and frailty. Instead, people make meaningful relationships with media representations of animals and wilder animals in the home's yard. This article uses the clinical timescale of visiting hours to interpret these alternative human-animal interactions and their temporal incongruities-to show how people make sense of differences they perceive between their own and animals' mortality and longevity, and how animals enable remembering and articulations of aging selfhood and social relations across the life course. A reinterpretation of visiting hours reveals the making of self-other distinctions in late life and temporal aspects of medical institutionalism that shape multispecies relations.
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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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Sasangohar F, Dhala A, Zheng F, Ahmadi N, Kash B, Masud F. Use of telecritical care for family visitation to ICU during the COVID-19 pandemic: an interview study and sentiment analysis. BMJ Qual Saf 2020; 30:715-721. [PMID: 33028659 PMCID: PMC8380894 DOI: 10.1136/bmjqs-2020-011604] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 05/21/2020] [Revised: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND When the COVID-19 pandemic restricted visitation between intensive care unit patients and their families, the virtual intensive care unit (vICU) in our large tertiary hospital was adapted to facilitate virtual family visitation. The objective of this paper is to document findings from interviews conducted with family members on three categories: (1) feelings experienced during the visit, (2) barriers, challenges or concerns faced using this service, and (3) opportunities for improvements. METHODS Family members were interviewed postvisit via phone. For category 1 (feelings), automated analysis in Python using the Valence Aware Dictionary for sentiment Reasoner package produced weighted valence (extent of positive, negative or neutral emotive connotations) of the interviewees' word choices. Outputs were compared with a manual coder's valence ratings to assess reliability. Two raters conducted inductive thematic analysis on the notes from these interviews to analyse categories 2 (barriers) and 3 (opportunities). RESULTS Valence-based and manual sentiment analysis of 230 comments received on feelings showed over 86% positive sentiments (88.2% and 86.8%, respectively) with some neutral (7.3% and 6.8%) and negative (4.5% and 6.4%) sentiments. The qualitative analysis of data from 57 participants who commented on barriers showed four primary concerns: inability to communicate due to patient status (44% of respondents); technical difficulties (35%); lack of touch and physical presence (11%); and frequency and clarity of communications with the care team (11%). Suggested improvements from 59 participants included: on demand access (51%); improved communication with the care team (17%); improved scheduling processes (10%); and improved system feedback and technical capabilities (17%). CONCLUSIONS Use of vICU for remote family visitations evoked happiness, joy, gratitude and relief and a sense of closure for those who lost loved ones. Identified areas for concern and improvement should be addressed in future implementations of telecritical care for this purpose.
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Affiliation(s)
- Farzan Sasangohar
- Industrial and Systems Engineering, Texas A&M University, College Station, Texas, USA .,Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas, USA
| | - Atiya Dhala
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Feibi Zheng
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Nima Ahmadi
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas, USA
| | - Bita Kash
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas, USA.,School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Faisal Masud
- Center for Critical Care, Houston Methodist Hospital, Houston, Texas, USA
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Seyedfatemi N, Mohammadi N, Hashemi S. Promoting patients health in intensive care units by family members and nurses: A literature review. J Educ Health Promot 2020; 9:114. [PMID: 32642470 PMCID: PMC7325791 DOI: 10.4103/jehp.jehp_506_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/23/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hospitalization in intensive care units (ICUs) can cause physiological and psychological challenges for patients and their family members. Using a family-centered approach in provision of visiting hours promotes the health of patients. The purpose of this study is to review the perception of nurses and family members of patients in ICUs about visiting their patients. METHODOLOGY The published articles in the last 10 years from 2008 to 2018 on the perception of nurses and family members of patients in critical care units about visiting their patients searched for in databases including ScienceDirect, PubMed, Cochrane, Google Scholar, SID, Scopus, CINAHL, OVID, IRANDOC, and Magiran using keywords "family members perception," "nurses' perception," "intensive care units," and "visiting" in English and Farsi, and finally, 15 articles were selected. RESULTS Results showed that nurses do not have appropriate viewpoint about visiting patients in ICUs, and they discussed and outlined the barriers of visiting patients given the benefits of family members' presence. CONCLUSION There are several limitations on the process of family members visiting their patients in the ICUs. It is essential to modify the nurses' attitudes and remove the organizational limitations in this area.
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Affiliation(s)
- Naiemeh Seyedfatemi
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Nooredin Mohammadi
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Hashemi
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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O’Sullivan BG, Joyce CM, McGrail MR. Rural outreach by specialist doctors in Australia: a national cross-sectional study of supply and distribution. Hum Resour Health 2014; 12:50. [PMID: 25189854 PMCID: PMC4161914 DOI: 10.1186/1478-4491-12-50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 06/17/2014] [Accepted: 08/22/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Outreach has been endorsed as an important global strategy to promote universal access to health care but it depends on health workers who are willing to travel. In Australia, rural outreach is commonly provided by specialist doctors who periodically visit the same community over time. However information about the level of participation and the distribution of these services nationally is limited. This paper outlines the proportion of Australian specialist doctors who participate in rural outreach, describes their characteristics and assesses how these characteristics influence remote outreach provision. METHODS We used data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey, collected between June and November 2008. Weighted logistic regression analyses examined the effect of covariates: sex, age, specialist residential location, rural background, practice arrangements and specialist group on rural outreach. A separate logistic regression analysis studied the effect of covariates on remote outreach compared with other rural outreach. RESULTS Of 4,596 specialist doctors, 19% (n = 909) provided outreach; of which, 16% (n = 149) provided remote outreach. Most (75%) outreach providers were metropolitan specialists. In multivariate analysis, outreach was associated with being male (OR 1.38, 1.12 to 1.69), having a rural residence (both inner regional: OR 2.07, 1.68 to 2.54; and outer regional/remote: OR 3.40, 2.38 to 4.87) and working in private consulting rooms (OR 1.24, 1.01 to 1.53). Remote outreach was associated with increasing 5-year age (OR1.17, 1.05 to 1.31) and residing in an outer regional/remote location (OR 10.84, 5.82 to 20.19). Specialists based in inner regional areas were less likely than metropolitan-based specialists to provide remote outreach (OR 0.35, 0.17 to 0.70). CONCLUSION There is a healthy level of interest in rural outreach work, but remote outreach is less common. Whilst most providers are metropolitan-based, rural doctors are more likely to provide outreach services. Remote distribution is influenced differently: inner regional specialists are less likely to provide remote services compared with metropolitan specialists. To benefit from outreach services and ensure adequate remote distribution, we need to promote coordinated delivery of services arising from metropolitan and rural locations according to rural and remote health need.
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Affiliation(s)
- Belinda G O’Sullivan
- />School of Rural Health, Office of Research, Monash University, Level 3, 26 Mercy St, PO Box 666, Bendigo, Victoria 3550 Australia
| | - Catherine M Joyce
- />Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, Victoria 3004 Australia
| | - Matthew R McGrail
- />School of Rural Health, Monash University, Northways Road, Churchill, Victoria 3842 Australia
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Abstract
Medical specialty training is changing which will result in shorter, more focused training programmes. Senior house officer posts will disappear from August 2007, and be replaced by training posts and trust grade doctors. Eventually specialist registrars in higher specialty training will join with these new training posts to create run-through training. Curricula development and delivery with quality assurance is now the responsibility of a new training board--the Postgraduate Medical Education and Training Board (PMETB). There is an opportunity to create a new specialty of acute medicine to help meet the crisis of care for acutely ill patients in our hospitals.
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Affiliation(s)
- C G Clough
- Joint Committee on Higher Medical Training, London
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Abstract
In an investigation of the impact of family visits on the behavior of 30 residents in dementia special care units, we found on direct observation that agitation decreased significantly during visits, but returned to the previous level within 30 minutes. No significant differences were found between visits by spouses or adult children. The premorbid quality of relationship was unrelated to family visitor enjoyment of visits or to differences between agitation level before and after visits. While 70 percent of visitors reported that they found visits pleasant (mean number of visits: 12.72 per month), 20 percent found visits unpleasant. Visitors' enjoyment or displeasure was significantly related to the difference between the number of pre-visit and post-visit agitated behaviors. Visitors indicated that the resident's mental status (33 percent) or difficulty communicating with the resident (30 percent) had the most negative impact on their visits. However, these factors appear amenable to education, suggesting that the quality of visits can be improved for visitor and resident with possibly greater positive impact on both.
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Affiliation(s)
- K Martin-Cook
- Caregiver Education Group, Alzheimer's Disease Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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