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BAJT M, JAGODIC KLIPŠTETER L, ZELKO E. Barriers and Facilitators of Family Meetings in Primary Palliative Care: Insights From Slovenia. Zdr Varst 2025; 64:112-120. [PMID: 40026373 PMCID: PMC11870319 DOI: 10.2478/sjph-2025-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 01/13/2025] [Indexed: 03/05/2025] Open
Abstract
Background Within palliative care, family meetings are recognised as the most effective practice for placing the patient and their family at the centre of care, thereby ensuring quality palliative care. The aim of this study was to determine how these meetings are conducted in primary healthcare and to identify the factors influencing them. Methods Sixteen semi-structured interviews were conducted with family physicians (FP) in Slovenia, who were expressly, and using the snowball method, invited to participate in the study. Transcripts were analysed using the principles of thematic analysis. Results It was found that participating FPs frequently discuss diseases, treatment, expectations and goals with patients and families. However, these discussions are seldom structured and fully conducted according to family meeting guidelines, primarily due to time constraints. Barriers to conducting family meetings include patient and family reluctance, the staff's lack of palliative care knowledge, time, and financial challenges. Positive factors include a good doctor-patient-family relationship, an exact diagnosis, the doctor's experience and competence, additional palliative care training and the presence of other team members. Conclusion Our research provides a unique insight into the implementation of family meetings at the primary level in Slovenia. FPs recognise numerous benefits of family meetings and consider them meaningful and time efficient. They emphasise that open discussions with the patient and their family are crucial for quality palliative care at the primary level. Considering simpler models of family meetings for the primary level appears sensible. Further research is needed to assess the cost-benefit relationship of family meetings.
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Affiliation(s)
- Mirjam BAJT
- Zdravstveni dom Logatec, Notranjska cesta 2, 1370Logatec, Slovenia
| | | | - Erika ZELKO
- Institute for General Medicine, Johannes Kepler University Linz, Altberger Strasse 69, 4040Linz, Austria
- Institute for Palliative Medicine, Medical Faculty, University of Maribor, Taborska cesta 9, 2000Maribor, Slovenia
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Rousseau AF, Thierry G, Lambermont B, Bonhomme V, Berger-Estilita J. Prehabilitation to mitigate postintensive care syndrome in surgical patients: The rationale for a peri-critical illness pathway involving anaesthesiologists and intensive care physicians. Eur J Anaesthesiol 2025; 42:419-429. [PMID: 39957494 DOI: 10.1097/eja.0000000000002136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 01/23/2025] [Indexed: 02/18/2025]
Abstract
The post-intensive care syndrome (PICS) refers to the long-term physical, psychological and cognitive impairments experienced by intensive care unit (ICU) survivors, while PICS-Family (PICS-F) affects their family members. Despite preventive strategies during the ICU stay, PICS remains a significant concern impacting survivors' quality of life, increasing the healthcare costs, and complicating recovery. Prehabilitation offers a promising approach to mitigating PICS and PICS-F, especially when the ICU stay can be anticipated, such as in the case of major surgery. Recent literature indicates that prehabilitation - interventions designed to enhance patients' functional capacity before critical illness - may mitigate the risk and severity of PICS. Studies have demonstrated that prehabilitation programs can improve muscle strength, reduce anxiety levels and enhance overall quality of life in ICU survivors. Family prehabilitation (prehabilitation-F) is also introduced as a potential intervention to help families to cope with the stress of critical illness. This article aims to explore the role of multimodal prehabilitation and post-ICU follow-up in preventing and managing PICS and PICS-F, focusing on improving patient outcomes, supporting families and optimising healthcare resources. Combining prehabilitation with post-ICU follow-up in peri-critical care clinics could streamline resources and improve outcomes, creating a holistic care pathway. These clinics, focused on both pre-ICU and post-ICU care, would thus address PICS from multiple angles. However, the heterogeneity of patient populations and prehabilitation protocols present challenges in standardising the interventions. Further research is necessary to establish optimal prehabilitation strategies tailored to individual patient needs and to demonstrate their utility in terms of patient outcome.
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Affiliation(s)
- Anne-Françoise Rousseau
- From the Department of Intensive Care, Liège University Hospital (A-FR, BL), Research Unit for a Life-Course perspective on Health & Education (RUCHE), Liège University, Liège, Belgium (A-FR), Inflammation and Enhanced Rehabilitation Laboratory (Regional Anesthesia and Analgesia), GIGA-Immunobiology Thematic Unit, GIGA-Research (A-FR, GT), Department of Anaesthesia, Liège University Hospital (GT, VB), Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research (VB), Interdisciplinary Centre of Algology, Liege University Hospital, Liege, Belgium (VB), Institute of Anaesthesiology and Intensive Care, Salemspital, Hirslanden Medical Group (JB-E), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E) and CINTESIS@RISE, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E)
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Peter PPR, Smriti S, Dhangar R, Hasija R, Choudhary R, Dhull R, Choudhary S, Yadav S, Kajla SM, Sahotra S, Yangchen S, Jain G, Sharma R. A mixed-method study to develop and evaluate a structured therapeutic communication module on psychological distress and perceived needs among caregivers of critically ill patients in Critical Care Units. Arch Psychiatr Nurs 2024; 52:89-100. [PMID: 39260990 DOI: 10.1016/j.apnu.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/30/2024] [Accepted: 07/06/2024] [Indexed: 09/13/2024]
Abstract
AIMS AND OBJECTIVES To develop and evaluate the effectiveness of a structured therapeutic communication module on psychological distress and perceived needs among caregivers of critically ill patients. BACKGROUND Caregivers of critically ill patients experience intense psychological distress, and their needs often go unexpressed or unidentified. Structured therapeutic communication enables nurses to explore and fulfill these needs. METHOD A mixed-method study was conducted among 30 caregivers of critically ill patients. During phase one, a qualitative interview was conducted, and a structured therapeutic communication module was developed based on Hildegard Peplau's Interpersonal Relations Theory. In the second phase, one group pre-test and post-test design was adopted. The Hospital Anxiety and Depression Scale (HADS) and a Semi-structured interview schedule were used to assess psychological distress and perceived needs, respectively. RESULTS Half of (50 %) the caregivers reported a high level of anxiety before intervention, with a mean of 11.30 (SD: 4.0), and 66.7 % of them had a high level of depression, with a mean of 12.03 (SD: 0.08). There was a statistically significant difference in anxiety (CI: 0.451-2.016) and depression (CI: 0.261-1.538) before and after the intervention. The qualitative analysis revealed unmet needs perceived by caregivers. CONCLUSION Using a structured therapeutic communication module helps nurses to alleviate the psychological distress experienced by caregivers of CCU patients. RELEVANCE TO CLINICAL PRACTICE Nurses need to be sensitive to the unexpressed needs of caregivers of critically ill patients. The structured therapeutic communication modules can be integrated into routine nursing care practice to ensure family-centered care.
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Affiliation(s)
| | - Smriti Smriti
- Department of Neurosurgery ICU, AIIMS Bhubaneswar, India
| | - Riddhima Dhangar
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | | | - Riya Dhull
- ICU, Nottingham University Hospital NHS, Nottingham, UK
| | | | - Sakshi Yadav
- Dept of General medicine, AIIMS Rishikesh, India
| | | | | | - Sonam Yangchen
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Gaurav Jain
- Department of Anaesthesiology and Critical Care, AIIMS Rishikesh, India
| | - Rakesh Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
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Krewulak KD, Jaworska N, Lee L, Louis JS, Dmitrieva O, Leia MP, Doig C, Niven DJ, Parhar KKS, Rochwerg B, West A, Stelfox HT, Leigh JP, Fiest KM. Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review. BMC Health Serv Res 2024; 24:936. [PMID: 39148067 PMCID: PMC11328402 DOI: 10.1186/s12913-024-11398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND We aimed to synthesize the qualitative evidence on the impacts of COVID-19-related restricted family presence policies from the perspective of patients, families, and healthcare professionals from neonatal (NICU), pediatric (PICU), or adult ICUs. METHODS We searched MEDLINE, EMBASE, Cochrane Databases of Reviews and Clinical Trials, CINAHL, Scopus, PsycINFO, and Web of Science. Two researchers independently reviewed titles/abstracts and full-text articles for inclusion. Thematic analysis was completed following appraising article quality and assessing confidence in the individual review findings using standardized tools. RESULTS We synthesized 54 findings from 184 studies, revealing the impacts of these policies in children and adults on: (1) Family integrated care and patient and family-centered care (e.g., disruption to breastfeeding/kangaroo care, dehumanizing of patients); (2) Patients, families, and healthcare professionals (e.g., negative mental health consequences, moral distress); (3) Support systems (e.g., loss of support from friends/families); and (4) Relationships (e.g., loss of essential bonding with infant, struggle to develop trust). Strategies to mitigate these impacts are reported. CONCLUSION This review highlights the multifaceted impacts of restricted visitation policies across distinct care settings and strategies to mitigate the harmful effects of these policies and guide the creation of compassionate family presence policies in future health crises. REGISTRATION https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290263 .
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Affiliation(s)
- Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Laurie Lee
- Department of Pediatrics, Cumming School of Medicine, Pediatric Intensive Care Unit, Children's Hospital Research Institute, Faculty of Nursing, University of Calgary, Calgary, Alberta, AB, Canada
| | - Julia St Louis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Olesya Dmitrieva
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Madison P Leia
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Christopher Doig
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Wang W, Liu X, Shen X, Zhang J, Zhang F, Liao L, He X, Liu Y. Emergency patients' satisfaction with humanistic caring and its associated factors in Chinese hospitals: a multi-center cross-sectional study. Front Public Health 2024; 12:1414032. [PMID: 39114520 PMCID: PMC11304506 DOI: 10.3389/fpubh.2024.1414032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/02/2024] [Indexed: 08/10/2024] Open
Abstract
Purpose Humanistic caring in clinical practice is important for quality care and patient satisfaction. This study aimed to assess patient satisfaction with humanistic care for emergency patients in China and its associated factors. Methods From October 2023 to December 2023, a multi-center cross-sectional survey was conducted across 28 provinces and 87 hospitals in China, using a sampling method for inpatients in emergency department. Patient satisfaction with humanistic care was evaluated by a self-developed questionnaire with 32 items across 6 dimensions. Stepwise multiple linear regression was used to explore associated factors. Results A total of 3,003 valid questionnaires were successfully collected, with an effective rate of 86.05%. The emergency patients' total mean humanistic caring satisfaction score was 4.67 ± 0.66. Age, medical insurance type, specialized emergency department visited, waiting times, whether had accompanied person, hospital level, and hospital type are correlated factors (P < 0.05) regarding humanistic caring satisfaction. The correlation analysis showed perceived value, and its three dimensions were moderately correlated with humanistic caring satisfaction. The multiple linear regression showed waiting time (β = -0.219, P < 0.05), whether had accompanied person (β = -0.192, P < 0.05), hospital level (β = -0.137, P < 0.05), functional value (β = 0.197, P < 0.05), and emotional value (β = 0.418, P < 0.05) were strong predictors. Conclusion Hospitals at all levels should improve patients' perceived value, shorten waiting times, and provide caregivers with improved humanistic care in the emergency department.
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Affiliation(s)
- Wei Wang
- Department of Nursing, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- School of Nursing, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinwen Liu
- Department of Nursing, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiulan Shen
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jichun Zhang
- Department of Nursing, People’s Hospital of Bortala Mongolian Autonomous Prefecture, Xinjiang, China
| | - Fengying Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lulu Liao
- School of Nursing, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoxiao He
- School of Nursing, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yilan Liu
- School of Nursing, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Steiner LM, Tolotti A, Valcarenghi D, Balice-Bourgois C, Luca CE, Villa M, Liptrott SJ, Biegger A, Bonetti L. "You always think the worst …" Family members' experiences during the COVID-19 emergency: A qualitative descriptive study. Aust Crit Care 2024; 37:659-666. [PMID: 38176994 DOI: 10.1016/j.aucc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
AIM The aim of this study was to explore the experiences of family members of patients admitted to the intensive care unit (ICU) for COVID-19 during the first and second waves of the pandemic in Switzerland. DESIGN A qualitative descriptive approach was used in this study. METHODS Face-to-face in-depth semistructured interviews were used to explore the experiences of family members of surviving COVID-19 patients, who were admitted to the ICU. Interviews were transcribed verbatim and wereanalysed using Braun and Clarke thematic analysis. In our context, family visits were prohibited during the first and second waves of the pandemic. FINDINGS Fifteen family members participated. Interviews were conducted between October 2020 and March 2021. Data analysis identified three main themes: (i) becoming a pillar of support for all; (ii) dealing with uncertainty; and (iii) a trajectory of emotions. Five subthemes are reported within these themes. The primary concern was the need for information due to visitation restrictions. This led to stress as many became the main communication source for other family members and friends. Coping strategies to support the ongoing uncertainty included daily routines, work, and prayer. The inability to visit and the lack of information led to a range of conflicting emotions, such as feeling of helplessness, which were countered by the gratitude that their loved ones had survived. CONCLUSION This study highlights the profound impact of the COVID-19 pandemic on the family members of ICU patients. It emphasises their struggle for information, adaptation to new roles, and coping mechanisms amidst uncertainty. Although they experienced predominantly negative emotions, the recovery and return of their loved ones triggered a sense of gratitude. This study sheds light on the crucial role of social support. Such findings may have implications for nursing practice in effectively addressing the concerns and priorities of family members in similar emergency situations, thereby improving clinical outcomes.
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Affiliation(s)
- Laura Maria Steiner
- Competence Centre of Nursing Research, Department of Nursing, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500, Bellinzona, Switzerland.
| | - Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500, Bellinzona, Switzerland
| | - Dario Valcarenghi
- Competence Centre of Nursing Research, Department of Nursing, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500, Bellinzona, Switzerland; Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500, Bellinzona, Switzerland
| | - Colette Balice-Bourgois
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Ospedale, 1, 6500, Bellinzona, Switzerland
| | - Corina Elena Luca
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500, Bellinzona, Switzerland; Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 46, 6900, Lugano, Switzerland
| | - Michele Villa
- Cardiocentro Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 48, 6900, Lugano, Switzerland
| | - Sarah Jayne Liptrott
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500, Bellinzona, Switzerland; Regional Hospital of Bellinzona e Valli, Ente Ospedaliero Cantonale (EOC), Via Ospedale, 12, 6500, Bellinzona, Switzerland
| | - Annette Biegger
- Nursing direction, Department of Nursing, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Loris Bonetti
- Competence Centre of Nursing Research, Department of Nursing, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500, Bellinzona, Switzerland
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Hayashi T, Bito S. Usage and limitations of medical consultation with patients' families using online video calls: a prospective cohort study. BMC Med Inform Decis Mak 2024; 24:139. [PMID: 38802921 PMCID: PMC11129502 DOI: 10.1186/s12911-024-02542-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Few studies have been conducted on the usage of telehealth focusing on consultations between patients' families and physicians. This study aimed to identify the usage and limitations of online medical consultations with patients' families compared to the traditional in-person consultations. METHODS We conducted a prospective cohort study from April 1, 2020, to September 30, 2021, at an educational acute-care hospital in Japan. The study included hospitalized patients aged 20 years or older and their family members for whom an online or in-person medical consultation between the family member and physician was conducted during the hospitalization period. The primary endpoints assessed were three topics pertaining to medical consultation: medical conditions and treatment plans, policies for life-threatening events, and post-discharge support. The secondary endpoint was the number of consultations required. RESULTS Online consultations and traditional in-person consultations were provided to 58 and 53 patients' families, respectively. Of the patients in the online consultation group who underwent multiple consultations, 46 (79%) also underwent in-person consultations. Regarding the topics, all the patients' families in both consultation groups had consultations on medical conditions and treatment plans; regarding the policy for life-threatening events, 47% of patient families in the online consultation group were consulted compared to 53% of those in the in-person group. Regarding post-discharge support, 59% of patient families in the online group were consulted compared to 40% in the in-person group. In the online consultation group of 58 patients' families, 188 consultations were conducted, including 95 online and 93 in-person consultations. Consultations on policy for life-threatening events were significantly more frequent in in-person consultations than in online consultations (p < 0.05). Regarding post-discharge support, online consultations were significantly more frequent than in-person consultations (p < 0.05). The number of family members who attended online consultations was significantly higher than those who attended in-person consultations (p < 0.05). CONCLUSIONS Online consultation between the physician and patient's family may be an alternative to in-person consultation for explaining medical conditions and treatment plans. However, in-person consultation still plays an important role in sensitive topics, such as policy consultation for life-threatening events.
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Affiliation(s)
- Tetsuro Hayashi
- Division of Clinical Epidemiology, NHO Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
| | - Seiji Bito
- Division of Clinical Epidemiology, NHO Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
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Cooper AS. Experiences and Needs of Families With a Relative Admitted to an Adult Intensive Care Unit. Crit Care Nurse 2024; 44:68-70. [PMID: 38555962 DOI: 10.4037/ccn2024571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Adam S Cooper
- Adam S. Cooper is the Director of Nursing Continuous Improvement and Affiliate Nursing Quality and Director of the UCSF JBI Centre for Evidence Implementation, UCSF Health, San Francisco, California. He is also a member of the Cochrane Nursing Care Field
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Kotfis K, Maj P, Szylińska A, Pankowiak M, Reszka E, Ely EW, Marra A. The spectrum of psychological disorders in family members of patients suffering from delirium associated with critical illness: a prospective, observational study. Sci Rep 2024; 14:4562. [PMID: 38402273 PMCID: PMC10894193 DOI: 10.1038/s41598-024-53968-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/07/2024] [Indexed: 02/26/2024] Open
Abstract
During intensive care unit admission, relatives of critically ill patients can experience emotional distress. The authors hypothesized that families of patients who are diagnosed with intensive care unit (ICU) delirium experience more profound depression and anxiety disorders related to stress than do families of patients without delirium. We performed a prospective observational single-center study including families of adult patients (age above 18 years) hospitalized in a 17-bed ICU of a university hospital for at least 48 h who completed research questionnaires at day 2 after admission and day 30 after initial evaluation using dedicated questionnaires (HADS, CECS, IES, PTSD-C). A total of 98 family members of patients hospitalized in the ICU were included in the final analysis (50 family members whose relatives were CAM-ICU positive (DEL+), and 48 family members of patients without delirium (DEL-)). No statistically significant differences in demographics and psychosocial data were found between the groups. In the follow-up 30 days after the first conversation with a family member, the mean PTSD score for the relatives of patients with delirium was 11.02 (Me = 13.0; SD = 5.74), and the mean score for nondelirious patients' family members was 6.42 (Me = 5.5; SD = 5.50; p < 0.001). A statistically significant increase in IES scores for family members of patients with delirium was observed for total PTSD (p = 0.001), IES-intrusion (p < 0.001), and IES-hyperarousal (p = 0.002). The prevalence of anxiety symptoms, depression, and posttraumatic stress disorder (PTSD) was higher in families of patients diagnosed with ICU delirium within 48 h of admission to the ICU. No factors increasing the depth of these disorders in family members of patients with ICU delirium were identified. Taking appropriate actions and thus providing families with appropriate support will contribute to the understanding of unfavorable emotional states, including anxiety, stress, depression, anger, agitation, or avoidance.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Care and Pain Management, Pomeranian Medical University, Szczecin, Poland.
| | | | | | - Maria Pankowiak
- Student Science Club at the Department of Anesthesiology, Intensive Care and Pain Management, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Reszka
- Student Science Club at the Department of Anesthesiology, Intensive Care and Pain Management, Pomeranian Medical University, Szczecin, Poland
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services Research, Nashville, TN, USA
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education and Clinical Center (GRECC) Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Napoli, NA, Italy
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Kruser JM, Ashana DC, Courtright KR, Kross EK, Neville TH, Rubin E, Schenker Y, Sullivan DR, Thornton JD, Viglianti EM, Costa DK, Creutzfeldt CJ, Detsky ME, Engel HJ, Grover N, Hope AA, Katz JN, Kohn R, Miller AG, Nabozny MJ, Nelson JE, Shanawani H, Stevens JP, Turnbull AE, Weiss CH, Wirpsa MJ, Cox CE. Defining the Time-limited Trial for Patients with Critical Illness: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2024; 21:187-199. [PMID: 38063572 PMCID: PMC10848901 DOI: 10.1513/annalsats.202310-925st] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
In critical care, the specific, structured approach to patient care known as a "time-limited trial" has been promoted in the literature to help patients, surrogate decision makers, and clinicians navigate consequential decisions about life-sustaining therapy in the face of uncertainty. Despite promotion of the time-limited trial approach, a lack of consensus about its definition and essential elements prevents optimal clinical use and rigorous evaluation of its impact. The objectives of this American Thoracic Society Workshop Committee were to establish a consensus definition of a time-limited trial in critical care, identify the essential elements for conducting a time-limited trial, and prioritize directions for future work. We achieved these objectives through a structured search of the literature, a modified Delphi process with 100 interdisciplinary and interprofessional stakeholders, and iterative committee discussions. We conclude that a time-limited trial for patients with critical illness is a collaborative plan among clinicians and a patient and/or their surrogate decision makers to use life-sustaining therapy for a defined duration, after which the patient's response to therapy informs the decision to continue care directed toward recovery, transition to care focused exclusively on comfort, or extend the trial's duration. The plan's 16 essential elements follow four sequential phases: consider, plan, support, and reassess. We acknowledge considerable gaps in evidence about the impact of time-limited trials and highlight a concern that if inadequately implemented, time-limited trials may perpetuate unintended harm. Future work is needed to better implement this defined, specific approach to care in practice through a person-centered equity lens and to evaluate its impact on patients, surrogates, and clinicians.
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Zheng Y, Zhang L, Ma S, Wu B, Chen P, Xu Y, Tan W, Li H, Wu Q, Zheng J. Care intervention on psychological outcomes among patients admitted to intensive care unit: an umbrella review of systematic reviews and meta-analyses. Syst Rev 2023; 12:237. [PMID: 38098025 PMCID: PMC10720116 DOI: 10.1186/s13643-023-02372-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Numerous studies have explored care interventions to improve the psychological outcome of intensive care unit (ICU) patients, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to get familiar with all available literature and find appropriate interventions. This umbrella review aimed to analyze the relationship between care intervention and psychological outcomes of ICU patients based on existing systematic reviews. METHODS An umbrella review of evidence across systematic reviews and meta-analyses published between 1987 and 2023 was undertaken. We systematically searched reviews that examined the association between care intervention and the improvement of adverse psychological outcomes in ICU patients using PubMed, EMBASE, Web of Science, Cochrane Library, and manual reference screening. The measurement tool (AMSTAR 2) was applied to evaluate the methodological quality of included studies. The excess significance bias, between-study heterogeneity expressed by I2, small-study effect, and evidence class were estimated. RESULTS A total of 5110 articles were initially identified from the search databases and nine of them were included in the analysis. By applying standardized criteria, only weak evidence was observed in 13 associations, even though most included reviews were of moderate to high methodological quality. These associations pertained to eight interventions (music therapy, early rehabilitation, post-ICU follow-up, ICU diary, information intervention, preoperative education, communication and psychological support, surrogate decision-making) and five psychological outcomes (post-intensive care syndrome, transfer anxiety, post-traumatic stress disorder, anxiety, and depression). Weak or null association was shown among the rest of the associations (e.g., weak association between music therapy and maternal anxiety or stress level). CONCLUSIONS The evidence of these eight supporting interventions to improve the adverse psychological outcomes of ICU patients and caregivers was weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence.
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Affiliation(s)
- Yafang Zheng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Lijuan Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Shihong Ma
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Bian Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Peipei Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Yan Xu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Wenting Tan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Hanzhan Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Qiaomei Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China.
| | - Jingxia Zheng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China.
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12
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Hoffmann M, Jeitziner MM, Riedl R, Mueller G, Peer A, Bachlechner A, Heindl P, Burgsteiner H, Schefold JC, von Lewinski D, Eller P, Pieber T, Sendlhofer G, Amrein K. Effects of an online information tool on post-traumatic stress disorder in relatives of intensive care unit patients: a multicenter double-blind, randomized, placebo-controlled trial (ICU-Families-Study). Intensive Care Med 2023; 49:1317-1326. [PMID: 37870597 PMCID: PMC10622355 DOI: 10.1007/s00134-023-07215-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/27/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Intensive care unit (ICU) hospitalization is challenging for the family members of the patients. Most family members report some level of anxiety and depression, sometimes even resulting in post-traumatic stress disorder (PTSD). An association has been reported between lack of information and PTSD. This study had three aims: to quantify the psychological burden of family members of critically ill patients, to explore whether a website with specific information could reduce PTSD symptoms, and to ascertain whether a website with information about intensive care would be used. METHOD A multicenter double-blind, randomized, placebo-controlled trial was carried out in Austria and Switzerland. RESULTS In total, 89 members of families of critically ill patients (mean age 47.3 ± 12.9 years, female n = 59, 66.3%) were included in the study. 46 relatives were allocated to the intervention website and 43 to the control website. Baseline Impact of Event Scale (IES) score was 27.5 ± 12.7. Overall, 50% showed clinically relevant PTSD symptoms at baseline. Mean IES score for the primary endpoint (~ 30 days after inclusion, T1) was 24 ± 15.8 (intervention 23.9 ± 17.9 vs. control 24.1 ± 13.5, p = 0.892). Hospital Anxiety and Depression Scale (HADS - Deutsch (D)) score at T1 was 12.2 ± 6.1 (min. 3, max. 31) and did not differ between groups. Use of the website differed between the groups (intervention min. 1, max. 14 vs. min. 1, max. 3; total 1386 "clicks" on the website, intervention 1021 vs. control 365). Recruitment was prematurely stopped in February 2020 due to coronavirus disease 2019 (COVID-19). CONCLUSION Family members of critically ill patients often have significant PTSD symptoms and online information on critical illness did not result in reduced PTSD symptoms.
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Affiliation(s)
- Magdalena Hoffmann
- Research Unit for Safety and Sustainability in Healthcare, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital of Graz, Graz, Austria
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Gerhard Mueller
- Department of Nursing Science and Gerontology, Institute of Nursing Science, UMIT TIROL - Private University of Health Sciences and Health Technology, Hall in Tyrol, Austria
| | - Andreas Peer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Patrik Heindl
- Department of Intensive Care, Vienna General Hospital, Vienna, Austria
| | - Harald Burgsteiner
- Institute for Digital Media Education, University College of Teacher Education Styria, Graz, Austria
| | - Joerg C Schefold
- Department of Intensive Care Medicine, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | | | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Pieber
- Research Unit for Safety and Sustainability in Healthcare, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety and Sustainability in Healthcare, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital of Graz, Graz, Austria
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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13
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Boerenbeker P, Brandén AS, Chaboyer W, Hilli Y, Johansson L. Family member's experiences with and evaluation of an ICU Liaison Nurse Service: A qualitative study. Nurs Crit Care 2023; 28:854-862. [PMID: 35396916 DOI: 10.1111/nicc.12775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Family members of critically ill patients often experience anxiety when their relatives are transferred from ICU to another level of care. ICU liaison nurse (ICULN) visits have been associated with improved support for patients, their families and nursing staff but has not been extensively studied in the non-English speaking setting. Yet, cross-country variations such as how hospital care is delivered and by who means that innovations such as the ICULN may not be able to be simply transferred to other contexts and may not have similar outcomes. AIM The aim of this study was to investigate family member's experiences with and evaluation of ICULN support service in one Swedish ICU. STUDY DESIGN A qualitative evaluation study was undertaken, recruiting family members of former ICU patients. Audio-taped in-depth interviews were conducted. Data were analysed by content analysis. FINDINGS Fifteen family members were interviewed. Two categories: Minds the gap between intensive care and the next care level and providing stability in an uncertain situation were identified. The ICULN supported the family members both directly, when the ICULNs listened to their questions and met their needs, and indirectly, when the ICULNs took responsibility for the patients and their physical and psychological conditions and wellbeing. CONCLUSION Families valued and were satisfied with the ICULN service but also gave suggestions to improve the service in this particular hospital context. RELEVANCE TO CLINICAL PRACTICE The study showed that an ICULN support service met several needs of family members and therefore was a beneficial way to support patients and family members in the transition from the ICU to the ward.
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Affiliation(s)
| | | | - Wendy Chaboyer
- Menzies Health Institute Queensland and the School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Yvonne Hilli
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Lotta Johansson
- Sahlgrenska University Hospital, Göteborg, Sweden
- Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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14
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Vogel G, Joelsson-Alm E, Forinder U, Svensen C, Sandgren A. Shifting focus: A grounded theory of how family members to critically ill patients manage their situation. Intensive Crit Care Nurs 2023; 78:103478. [PMID: 37384978 DOI: 10.1016/j.iccn.2023.103478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Critical illness is a life-threatening condition for the patient, which affects their family members as a traumatic experience. Well-known long-term consequences include impact on mental health and health-related quality of life. This study aims to develop a grounded theory to explain pattern of behaviours in family members of critically ill patients cared for in an intensive care unit, addressing the period from when the patient becomes critically ill until recovery at home. RESEARCH METHODOLOGY/DESIGN We used a classic grounded theory to explore the main concern for family members of intensive care patients. Fourteen interviews and seven observations with a total of 21 participants were analysed. Data were collected from February 2019 to June 2021. SETTING Three general intensive care units in Sweden, consisting of a university hospital and two county hospitals. FINDINGS The theory Shifting focus explains how family members' main concern, living on hold, is managed. This theory involves different strategies: decoding, sheltering and emotional processing. The theory has three different outcomes: adjusting focus, emotional resigning or remaining in focus. CONCLUSION Family members could stand in the shadow of the patients' critical illness and needs. This emotional adversity is processed through shifting focus from one's own needs and well-being to the patient's survival, needs and well-being. This theory can raise awareness of how family members of critically ill patients manage the process from critical illness until return to everyday life at home. Future research focusing on family members' need for support and information, to reduce stress in everyday life, is needed. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals should support family members in shifting focus by interaction, clear and honest communication, and through mediating hope.
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Affiliation(s)
- Gisela Vogel
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Ulla Forinder
- Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, SE-801 76 Gävle, Sweden.
| | - Christer Svensen
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, SE-352 52 Växjö, Sweden.
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15
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Renckens SC, Pasman HR, Klop HT, du Perron C, van Zuylen L, Steegers MAH, Ten Tusscher BL, Abbink FCH, de Ruijter W, Vloet LCM, Koster SCE, Onwuteaka-Philipsen BD. Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:763. [PMID: 37464434 DOI: 10.1186/s12913-023-09756-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Support for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences. METHODS We performed a cross-sectional multicentre cohort study in six Dutch ICUs in the Netherlands. Written questionnaires were distributed among relatives of ICU patients from pre-COVID-19, the first wave and the second wave. The questionnaire included questions on demographics, the organisation of support, and the experiences and satisfaction of relatives with the support. RESULTS A total of 329 relatives completed the questionnaire (52% partner, 72% woman and 63% ICU stay of 11 days or longer). Support for relatives of ICU patients during the first COVID-19 wave differed significantly from pre-COVID-19 and the second wave. Differences were found in all categories of elements of support: who, when, how and what. Overall, relatives from the three time periods were very positive about the support. The only difference in satisfaction between the three time periods, was the higher proportion of relatives indicating that healthcare professionals had enough time for them during the first wave. Elements of support which were associated with many positive experiences and satisfaction were: fixed timeslot, receiving information (e.g. leaflets) on ≥ 2 topics, discussing > 5 topics with healthcare professionals, and being offered emotional support. CONCLUSIONS Although, support for relatives in the ICU changed considerably during the COVID-19 pandemic, relatives were still positive about this support. The altered support gave insight into avenues for improvement for future comparable situations as well as for normal daily ICU practice: e.g. daily contact at a fixed timeslot, offering video calling between patients and relatives, and offering emotional support. ICUs should consider which elements need improvement in their practice.
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Affiliation(s)
- Sophie C Renckens
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands.
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands.
| | - H Roeline Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Viaa University of Applied Sciences, Zwolle, The Netherlands
| | - Chantal du Perron
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
| | - Lia van Zuylen
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Monique A H Steegers
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Birkitt L Ten Tusscher
- Department of Intensive Care Medicine, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Floor C H Abbink
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter de Ruijter
- Department of Intensive Care Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Lilian C M Vloet
- Foundation Family and Patient Centered Intensive Care (FCIC), Alkmaar, The Netherlands
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Stephanie C E Koster
- Department of Anaesthesiology and Department of Intensive Care Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
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16
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Monti L, Marconi E, Bocci MG, Kotzalidis GD, Mazza M, Galliani C, Tranquilli S, Vento G, Conti G, Sani G, Antonelli M, Chieffo DPR. COVID-19 pandemic in the intensive care unit: Psychological implications and interventions, a systematic review. World J Psychiatry 2023; 13:191-217. [PMID: 37123099 PMCID: PMC10130962 DOI: 10.5498/wjp.v13.i4.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/06/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff; this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.
AIM To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.
METHODS We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles, upon which we commented.
RESULTS Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.
CONCLUSION As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.
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Affiliation(s)
- Laura Monti
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Elisa Marconi
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Maria Grazia Bocci
- UOC Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Georgios Demetrios Kotzalidis
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- NESMOS Department, Facoltà di Medicina e Psicologia, Sant’Andrea University Hospital, Rome 00189, Italy
| | - Marianna Mazza
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Carolina Galliani
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Tranquilli
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giovanni Vento
- UOC Neonatologia, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- UOC Neonatologia, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giorgio Conti
- UOC Terapia Intensiva Pediatrica e Trauma Center Pediatrico, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- UOC Terapia Intensiva Pediatrica e Trauma Center Pediatrico, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gabriele Sani
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Massimo Antonelli
- UOC Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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17
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Vanhanen M, Meriläinen MH, Ala-Kokko T, Kyngäs H, Kaakinen P. Family members' perceptions of counselling during visits to loved ones in an adult ICU. Nurs Open 2023. [PMID: 37018387 DOI: 10.1002/nop2.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
AIMS The study's aims were to (1) assess family members' perceptions of the quality of the counselling they received while visiting a loved one in an adult ICU and (2) identify factors that influence family members' perceptions of counselling quality. DESIGN A cross-sectional survey of visiting family members of adult ICU patients. METHODS Family members (n = 55) at eight ICUs across five Finnish university hospitals completed a cross-sectional survey. RESULTS Family members assessed the quality of counselling in adult ICUs to be good. Factors associated with the quality of counselling were knowledge, family-centred counselling, and interaction. Family members' ability to live normally was associated with understanding of the loved one's situation (ρ = 0.715, p < 0.001). Interaction was associated with understanding (ρ = 0.715, p < 0.001). Family members felt that intensive care professionals did not adequately ensure that they understood counselling-related issues and that they lacked opportunities to give feedback, in 29% of cases, staff asked the family members whether they understood the counselling and 43% of family members had opportunities to offer feedback. However, the family members felt that the counselling they received during ICU visits was beneficial.
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Affiliation(s)
- Minna Vanhanen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Oulu University of Applied Sciences, Oulu, Finland
| | - Merja H Meriläinen
- Wellbeing Services County of North Ostrobothnia, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
| | - Tero Ala-Kokko
- Oulu University Hospital, Oulu, Finland
- Oulu University Hospital, Medical Research Center Oulu University Medical Faculty, Research Group of Intensive Care Medicine, Oulu University Hospital, University of Oulu and Medical Research Center (MRC), Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Pirjo Kaakinen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
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18
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Reifarth E, Garcia Borrega J, Kochanek M. How to communicate with family members of the critically ill in the intensive care unit: A scoping review. Intensive Crit Care Nurs 2023; 74:103328. [PMID: 36180318 DOI: 10.1016/j.iccn.2022.103328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To map the existing approaches to communication with family members of the critically ill in the intensive care unit and the corresponding implementation requirements and benefits. METHODS We conducted a scoping review in February 2022 by searching PubMed, CINAHL, APA PsycINFO, and Cochrane Library for articles published between 2000 and 2022. We included records of all designs that met our inclusion criteria and applied frequency counts and qualitative coding. RESULTS The search yielded 3749 records, 63 met inclusion criteria. The included records were of an interventional (43 %) or observational (14 %) study design or review articles (43 %), and provided information in three categories: communication platforms, strategies, and tools. For implementation in the intensive care unit, the approaches required investing time and resources. Their reported benefits were an increased quality of communication and satisfaction among all parties involved, improved psychological outcome among family members, and reduced intensive care unit length of stay and costs. CONCLUSION The current approaches to communication with patients' family members offer insights for the development and implementation of communication pathways in the intensive care unit of which the benefits seem to outweigh the efforts. Structured interprofessional frameworks with standardised tools based on empathic communication strategies are encouraged.
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Affiliation(s)
- Eyleen Reifarth
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Jorge Garcia Borrega
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Matthias Kochanek
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
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Psychosoziale Angehörigenversorgung: Rahmenkonzept für Intensivstationen. Med Klin Intensivmed Notfmed 2022; 117:600-606. [DOI: 10.1007/s00063-022-00966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/16/2022] [Indexed: 11/05/2022]
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Makris D, Tsolaki V, Robertson R, Dimopoulos G, Rello J. The future of training in intensive care medicine: A European perspective. JOURNAL OF INTENSIVE MEDICINE 2022; 3:52-61. [PMID: 36789360 PMCID: PMC9923960 DOI: 10.1016/j.jointm.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Ross Robertson
- Medical School, University of Thessaly, Larisa 41110, Greece
| | - George Dimopoulos
- Third Department of Critical Care, Medical School, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Jordi Rello
- CRIPS Department, Vall d'Hebron Institut of Research, Barcelona 08035, Spain,Clinical Research, CHU Nîmes, Nîmes 30029, France,Medical School, Universitat Internacional de Catalunya, Campus Sant Cugat, Sant Cugat del Valles, Barcelona 08195, Spain,Corresponding author: Jordi Rello, CRIPS Department, Vall d'Hebron Institut of Research, Barcelona 08035, Spain.
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Jöbges S, Denke C, Seidlein AH. Optimierung der Zugehörigenbetreuung – angehörigenzentrierte Intensivmedizin. Med Klin Intensivmed Notfmed 2022; 117:575-583. [DOI: 10.1007/s00063-022-00964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/29/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022]
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22
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Wu Y, Wang G, Zhang Z, Fan L, Ma F, Yue W, Li B, Tian J. Efficacy and safety of unrestricted visiting policy for critically ill patients: a meta-analysis. Crit Care 2022; 26:267. [PMID: 36064613 PMCID: PMC9446669 DOI: 10.1186/s13054-022-04129-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/19/2022] [Indexed: 12/27/2022] Open
Abstract
Aim To compare the safety and effects of unrestricted visiting policies (UVPs) and restricted visiting policies (RVPs) in intensive care units (ICUs) with respect to outcomes related to delirium, infection, and mortality. Methods MEDLINE, Cochrane Library, Embase, Web of Science, CINAHL, CBMdisc, CNKI, Wanfang, and VIP database records generated from their inception to 22 January 2022 were searched. Randomized controlled trials and quasi-experimental studies were included. The main outcomes investigated were delirium, ICU-acquired infection, ICU mortality, and length of ICU stay. Two reviewers independently screened studies, extracted data, and assessed risks of bias. Random‑effects and fixed-effects meta‑analyses were conducted to obtain pooled estimates, due to heterogeneity. Meta-analyses were performed using RevMan 5.3 software. The results were analyzed using odds ratios (ORs), 95% confidence intervals (CIs), and standardized mean differences (SMDs). Results Eleven studies including a total of 3741 patients that compared UVPs and RVPs in ICUs were included in the analyses. Random effects modeling indicated that UVPs were associated with a reduced incidence of delirium (OR = 0.4, 95% CI 0.25–0.63, I2 = 71%, p = 0.0005). Fixed-effects modeling indicated that UVPs did not increase the incidences of ICU-acquired infections, including ventilator-associated pneumonia (OR = 0.96, 95% CI 0.71–1.30, I2 = 0%, p = 0.49), catheter-associated urinary tract infection (OR 0.97, 95% CI 0.52–1.80, I2 = 0%, p = 0.55), and catheter-related blood stream infection (OR = 1.15, 95% CI 0.72–1.84, I2 = 0%, p = 0.66), or ICU mortality (OR = 1.03, 95% CI 0.83–1.28, I2 = 49%, p = 0.12). Forest plotting indicated that UVPs could reduce the lengths of ICU stays (SMD = − 0.97, 95% CI − 1.61 to 0.32, p = 0.003). Conclusion The current meta-analysis indicates that adopting a UVP may significantly reduce the incidence of delirium in ICU patients, without increasing the risks of ICU-acquired infection or mortality. Further large-scale, multicenter studies are needed to confirm these indications. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04129-3.
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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: 0.7] [Reference Citation Analysis] [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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Kotfis K, van Diem-Zaal I, Williams Roberson S, Sietnicki M, van den Boogaard M, Shehabi Y, Ely EW. The future of intensive care: delirium should no longer be an issue. Crit Care 2022; 26:200. [PMID: 35790979 PMCID: PMC9254432 DOI: 10.1186/s13054-022-04077-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023] Open
Abstract
In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A-F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a 'home-like' (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Szczecin, Poland.
| | - Irene van Diem-Zaal
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Shawniqua Williams Roberson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services Research, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Marek Sietnicki
- Department of Architecture, West Pomeranian University of Technology in Szczecin, Szczecin, Poland
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Yahya Shehabi
- Monash Health School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.,School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services Research, Nashville, TN, USA.,Division of Allergy, Department of Medicine, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Geriatric Research, Education and Clinical Center (GRECC) Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
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25
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Naef R, Filipovic M, Jeitziner MM, von Felten S, Safford J, Riguzzi M, Rufer M. A multicomponent family support intervention in intensive care units: study protocol for a multicenter cluster-randomized trial (FICUS Trial). Trials 2022; 23:533. [PMID: 35761343 PMCID: PMC9235279 DOI: 10.1186/s13063-022-06454-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/08/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Family members of critically ill patients face considerable uncertainty and distress during their close others' intensive care unit (ICU) stay. About 20-60% of family members experience adverse mental health outcomes post-ICU, such as symptoms of anxiety, depression, and posttraumatic stress. Guidelines recommend structured family inclusion, communication, and support, but the existing evidence base around protocolized family support interventions is modest and requires substantiation. METHODS To test the clinical effectiveness and explore the implementation of a multicomponent, nurse-led family support intervention in ICUs, we will undertake a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 1 trial. It will include eight clusters (ICUs) per study arm, with a projected total sample size of 896 family members of adult, critically ill patients treated in the German-speaking part of Switzerland. The trial targets family members of critically ill patients with an expected ICU stay of 48 h or longer. Families in the intervention arm will receive a family support intervention in addition to usual care. The intervention consists of specialist nurse support that is mapped to the patient pathway with follow-up care and includes psycho-educational and relationship-focused family interventions, and structured, interprofessional communication, and shared decision-making with families. Families in the control arm will receive usual care. The primary study endpoint is quality of family care, operationalized as family members' satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and family members' mental health (well-being, psychological distress) measured at admission, discharge, and after 3, 6, and 12 months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference. DISCUSSION This trial will examine the effectiveness of the family support intervention and generate knowledge of its implementability. Both types of evidence are necessary to determine whether the intervention works as intended in clinical practice and could be scaled up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being. TRIAL REGISTRATION ClinicalTrials.gov NCT05280691 . Prospectively registered on 20 February 2022.
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Affiliation(s)
- Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitätsstrasse 84, 8006 Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Miodrag Filipovic
- Surgical Intensive Care Unit, Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Cantonal Hospital of St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 16, CH10, Bern, Switzerland
| | - Stefanie von Felten
- Department of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute, Faculty of Medicine, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | | | - Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitätsstrasse 84, 8006 Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Michael Rufer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Psychiatry and Psychotherapy, Clinic Zugersee, Triaplus AG, Widenstrasse 55, 6317 Oberwil-Zug, Switzerland
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Glajchen M, Goehring A, Johns H, Portenoy RK. Family Meetings in Palliative Care: Benefits and Barriers. Curr Treat Options Oncol 2022; 23:658-667. [PMID: 35316479 PMCID: PMC8938578 DOI: 10.1007/s11864-022-00957-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/05/2022]
Abstract
OPINION STATEMENT Specialists in palliative care view the family meeting as a means to engage patients and their families in a serious illness discussion that may clarify the values of patients and caregivers, provide information, determine care preferences, and identify sources of illness-related distress and burden. The family meeting is considered the best practice for achieving patient- and family-centered care in palliative care. Although studies of the family meeting are limited, those extant suggest that these interventions may reduce caregiver distress, mitigate the perception of unmet needs, prepare family members for caregiving, and improve bereavement outcomes. The experience of palliative care specialists further suggests that the family meeting may reinforce the therapeutic alliance with families, promote consensus, and reduce the need for ad hoc meetings. Physician satisfaction may be enhanced when the treatment plan includes the opportunity to show empathy and see the family's perspective-core elements of the clinical approach to the family meeting. In the oncology setting, the potential to achieve these positive outcomes supports the integration of the family meeting into practice. Clinical skills for the planning and running of family meetings should be promoted with consideration of a standardized protocol for routine family meetings at critical points during the illness and its treatment using an interdisciplinary team. Further research is needed to refine understanding of the indications for the family meeting and determine the optimal timing, structure, and staffing models. Outcome studies employing validated measures are needed to better characterize the impact of family meetings on patient and family distress and on treatment outcomes. Although better evidence is needed to guide the future integration of the family meeting into oncology practice, current best practices can be recommended based on available data and the extensive observations of palliative care specialists.
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Affiliation(s)
- Myra Glajchen
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006 USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Hannah Johns
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006 USA
| | - Russell K. Portenoy
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006 USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY USA
- MJHS Hospice and Palliative Care, New York, NY USA
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Cui N, Yan X, Zhang Y, Chen D, Zhang H, Zheng Q, Jin J. Non-Pharmacological Interventions for Minimizing Physical Restraints Use in Intensive Care Units: An Umbrella Review. Front Med (Lausanne) 2022; 9:806945. [PMID: 35573001 PMCID: PMC9091438 DOI: 10.3389/fmed.2022.806945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Background There is a relationship between the application of physical restraints and negative physiological and psychological effects on critically ill patients. Many organizations have supported and advocated minimizing the use of physical restraints. However, it is still common practice in many countries to apply physical restraints to patients in intensive care. Objective This study aimed to assess the effectiveness of various non-pharmacological interventions used to minimize physical restraints in intensive care units and provide a supplement to the evidence summary for physical restraints guideline adaptation. Methods Based on the methodology of umbrella review, electronic databases, including Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, MEDLINE, EMBASE, CINAHL, Web of Science, PsycInfo/Psyc Articles/Psychology and Behavioral Science Collection, China National Knowledge Infrastructure, SinoMed, and Wanfang Data, were searched to identify systematic reviews published from January 2016 to December 2020. Two independent reviewers undertook screening, data extraction, and quality appraisal. The methodological quality of systematic reviews was evaluated by AMSTAR 2. Evidence quality of each intervention was assessed according to GRADE. The corrected covered area was calculated as a measure of overlap. Results A total of 47 systematic reviews were included in the umbrella review, of which six were evaluated as high quality, five were of moderate quality, and the rest were of low or critically low quality. The corrected covered area range was from 0.0 to 0.269, which indicated that there was mild overlap between systematic reviews. The included systematic reviews evaluated various types of non-pharmacological interventions for minimizing physical restraints in intensive care units, which included multicomponent interventions involving healthcare professionals' education, family engagement/support, specific consultations and communication, rehabilitation and mobilization (rehabilitation techniques, early mobilization, inspiratory muscle training), interventions related to reducing the duration of mechanical ventilation (weaning modes or protocols, ventilator bundle or cough augmentation techniques, early tracheostomy, high-flow nasal cannula), and management of specific symptoms (delirium, agitation, pain, and sleep disturbances). Conclusion The number of systematic reviews related to physical restraints was limited. Multicomponent interventions involving healthcare professionals' education may be the most direct non-pharmacological intervention for minimizing physical restraints use in intensive care units. However, the quality of evidence was very low, and conclusions should be taken with caution. Policymakers should consider incorporating non-pharmacological interventions related to family engagement/support, specific consultations and communication, rehabilitation and mobilization, interventions related to reducing the duration of mechanical ventilation, and management of specific symptoms as part of the physical restraints minimization bundle. All the evidence contained in the umbrella review provides a supplement to the evidence summary for physical restraints guideline adaptation. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242586, identifier: CRD42021242586.
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Affiliation(s)
- Nianqi Cui
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Xiaoli Yan
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Dandan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Zheng
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
- Changxing Branch Hospital of SAHZU, Huzhou, China
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Yu WC, Huang CT, Sheng WH. Application of a pre-emptive question and answer platform to improve the level of satisfaction during family meetings in general medical wards. BMC Health Serv Res 2022; 22:499. [PMID: 35422016 PMCID: PMC9008296 DOI: 10.1186/s12913-022-07929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/31/2022] [Indexed: 12/03/2022] Open
Abstract
Background A successful family meeting is key to family-centered care and may foster communication and improve the level of satisfaction of the family in terms of communication. In this study, we evaluated whether a proactive communication channel could improve the level of satisfaction of family members following a family meeting in a general medical ward setting. Methods We conducted a pre- and post-study to compare the level of satisfaction of a family with a family meeting before (N = 39) and after (N = 29) intervention in two general medical wards of a tertiary-care referral center. The intervention included a pre-emptive question and answer platform and a written response to family-raised queries in addition to a regular setting. Following each family meeting, family members were requested to fill a 10-item survey assessing their levels of satisfaction. Results The characteristics of the family members in terms of demographics, education levels, and previous experiences with family meetings in the pre- and post-intervention groups were similar. The scores in all the items that indicated the level of satisfaction significantly improved after intervention. The overall score for satisfaction increased from 85 (interquartile range, 80–95) to 98 (interquartile range, 93–100; P < 0.001). Conclusions Compared with conventional practice, the inclusion of a proactive communication platform along with a written response to raised queries as a part of family meetings improved the satisfaction levels of the family in terms of the content and process of the meeting in the general ward setting. Further studies are needed to delineate the optimal timing and use of such a communication modality. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07929-z.
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29
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Coelho AC, Lopes CT, Lopes JDL, Santos VB, Barros ALBLD. Needs of family members of patients in a coronary care unit. EINSTEIN-SAO PAULO 2022; 20:eAO6258. [PMID: 35293433 PMCID: PMC8909121 DOI: 10.31744/einstein_journal/2022ao6258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/15/2021] [Indexed: 11/05/2022] Open
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30
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Chanchalani G, Arora N, Nasa P, Sodhi K, Bahrani MJA, Tayar AA, Hashmi M, Jaiswal V, Kantor S, Lopa AJ, Mansour B, Mudalige AD, Nadeem R, Shrestha GS, Taha AR, Türkoğlu M, Weeratunga D. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022; 26:268-275. [PMID: 35519910 PMCID: PMC9015923 DOI: 10.5005/jp-journals-10071-24091] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose The coronavirus disease-2019 (COVID-19) pandemic had affected the visiting or communicating policies for family members. We surveyed the intensive care units (ICUs) in South Asia and the Middle East to assess the impact of the COVID-19 pandemic on visiting and communication policies. Materials and method A web-based cross-sectional survey was used to collect data between March 22, 2021, and April 7, 2021, from healthcare professionals (HCP) working in COVID and non-COVID ICUs (one response per ICU). The topics of the questionnaire included current and pre-pandemic policies on visiting, communication, informed consent, and end-of-life care in ICUs. Results A total of 292 ICUs (73% of COVID ICUs) from 18 countries were included in the final analysis. Most (92%) of ICUs restricted their visiting hours, and nearly one-third (32.3%) followed a "no-visitor" policy. There was a significant change in the daily visiting duration in COVID ICUs compared to the pre-pandemic times (p = 0.011). There was also a significant change (p <0.001) in the process of informed consent and end-of-life discussions during the ongoing pandemic compared to pre-pandemic times. Conclusion Visiting and communication policies of the ICUs had significantly changed during the COVID-19 pandemic. Future studies are needed to understand the sociopsychological and medicolegal implications of revised policies. How to cite this article Chanchalani G, Arora N, Nasa P, Sodhi K, Al Bahrani MJ, Al Tayar A, et al. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022;26(3):268-275.
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Affiliation(s)
- Gunjan Chanchalani
- Department of Critical Care Medicine, Cumballa Hill Hospital, Mumbai, Maharashtra, India
| | - Nitin Arora
- Department of Intensive Care, University Hospitals Birmingham, Birmingham, West Midlands, United Kingdom
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | | | - Maher J Al Bahrani
- Department of Anesthesiology and Critical Care Medicine, Royal Hospital, Muscat, Oman
| | - Ashraf Al Tayar
- Department of ICU, Security Force Hospital, Dammam, Saudi Arabia
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University and Dr Ziauddin Hospital, Karachi, Pakistan
| | - Vinod Jaiswal
- Department of Critical Care Medicine, Amina Hospital, Ajman, United Arab Emirates
| | - Sandeep Kantor
- Department of Critical Care Medicine, Royal Hospital, Muscat, Oman
| | - Ahsina J Lopa
- Department of Intensive Care Unit, MH Samorita Hospital and Medical College, Tejgaon, Dhaka, Bangladesh
| | - Bassam Mansour
- Department of Pulmonary Medicine and Critical Care Medicine, Zahraa Hospital University Medical Center/Lebanese University, Faculty of Medical Science, Beirut, Lebanon
| | - Anushka D Mudalige
- Department of Critical Care Medicine, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Rashid Nadeem
- Department of Critical Care Medicine, Dubai Hospital, Dubai, United Arab Emirates
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Lalitpur, Nepal
| | - Ahmed R Taha
- Department of Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Melda Türkoğlu
- Department of Internal Medicine, Division of Critical Care, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Dameera Weeratunga
- Department of Critical Care Medicine, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Halain AA, Yoong TL, Chan CM, Ibrahim NA, Abdullah KL. DEVELOPMENT AND VALIDATION OF AN EDUCATIONAL INFORMATION WEB PAGE FOR FAMILY MEMBERS WITH RELATIVES IN THE INTENSIVE CARE UNIT (ICU). Nurse Educ Pract 2022; 61:103324. [DOI: 10.1016/j.nepr.2022.103324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/03/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
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Boltey EM, Wright N, Mosley EA, White MR, Iwashyna TJ, Manojlovich M, Costa DK. Exploring the process of information sharing in an adult intensive care unit: an ethnographic study. J Interprof Care 2022; 36:168-176. [PMID: 33906566 PMCID: PMC8548388 DOI: 10.1080/13561820.2021.1899147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Information sharing, a component of patient and family engagement (PFE), is an important process that may contribute to intensive care unit (ICU) quality of care. Yet, virtually no studies explore how the process of information sharing unfolds in the ICU from the interprofessional team and family member perspectives. To better understand the process of information sharing, we conducted ethnographic fieldwork in a 20-bed medical ICU, focusing on behaviors and interactions of the interprofessional team and family members (May 2016 - October 2016). We completed 17.5 observation hours, 6 shadowing sessions, and 12 semi-structured interviews with 17 total participants. We used thematic content analysis and iterative inductive coding to identify three themes about the information sharing process: 1) family factors (health literacy and past experience with the ICU environment) influence information sharing; 2) clinicians strategies can support engagement in the process of information sharing (assessing families' need for information, understanding a families' hope, using rounds as an opportunity for information sharing); 3) the process of information sharing allows for trust building between families and the ICU team. Our findings suggest that information sharing is a crucial process that may serve as a catalyst for effective patient and family engagement in the ICU.
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Affiliation(s)
| | - Nathan Wright
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor Michigan
| | | | | | - Theodore J. Iwashyna
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor MI,VA Ann Arbor, Center for Clinical Management Research, Ann Arbor MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor MI
| | - Milisa Manojlovich
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor MI
| | - Deena Kelly Costa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor MI
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Larsen MH, Johannessen GI, Heggdal K. Nursing interventions to cover patients' basic needs in the intensive care context - A systematic review. Nurs Open 2022; 9:122-139. [PMID: 34729954 PMCID: PMC8685812 DOI: 10.1002/nop2.1110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/25/2021] [Accepted: 10/15/2021] [Indexed: 01/04/2023] Open
Abstract
AIM To examine the content, theoretical frameworks and effectiveness of nursing interventions utilizing patient-reported outcome measures (PROMs) in the intensive care unit (ICU). DESIGN A systematic review and narrative synthesis following the guidelines of the preferred reporting items for systematic reviews and meta-analysis checklist. METHODS We searched the MEDLINE, CINAHL, PsycINFO, SweMed and Cochrane controlled trials register (CENTRAL) databases for studies evaluating interventions primarily delivered by nurses in the ICU. Two independent reviewers performed study selection, data extraction and risk of bias. RESULTS Twenty-two studies were included, whereas only seven studies used a theoretical framework. The interventions were heterogeneous in content, duration and choice of PROMs. Outcomes were related to covering patients' and families' basic needs, described by Henderson as essential functions of nursing. Several studies reported positive intervention effects, and nurses' communication and psychosocial care were considered essential components of nursing interventions in the ICU.
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Kiwanuka F, Sak-Dankosky N, Alemayehu YH, Nanyonga RC, Kvist T. The evidence base of nurse-led family interventions for improving family outcomes in adult critical care settings: A mixed method systematic review. Int J Nurs Stud 2022; 125:104100. [PMID: 34736074 PMCID: PMC8560087 DOI: 10.1016/j.ijnurstu.2021.104100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/05/2021] [Accepted: 09/25/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated the consequences of a patient's admission to critical care settings, causing families to face more psychosocial issues than in previous years. Thus, nurses and other clinicians need to keep abreast of interventions that support the families of critical care patients. OBJECTIVE To provide evidence of nurse-led family interventions and their family outcomes in adult critical care settings. DESIGN A mixed method systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. DATA SOURCES The search included both a screen of relevant databases (PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Library) and the screening of citations in relevant articles. Studies published in the English language between January 2010 and October 2020 were considered. The final database searches were performed on 20 October 2020. METHODS Screening and eligibility assessment were conducted using the Rayyan software. Studies describing the family outcomes of nurse-led interventions in adult critical care settings through either qualitative or quantitative methods were included, i.e., the mixed method synthesis permitted the inclusion of either qualitative or quantitative findings. Article quality was evaluated by three authors using the Joanna Briggs Institute's critical appraisal tools. FINDINGS A total of 15 studies - two trials, eight quasi-experimental studies, four qualitative, and one mixed method met the inclusion criteria. The described interventions were organized into five categories: educational/informational; family involvement in care; diary; communication; and bundled interventions. These categories varied in terms of elements, delivery, and family outcomes. Nurse-led interventions that resulted in small to medium improvements in family outcomes included educational interventions with digital storytelling, a bundled approach, informational nursing interventions, and nurse-driven emotional support. The included studies (n = 2) that investigated family rounds in the ICU reported that this approach did not noticeably influence family outcomes. CONCLUSION The differences in the intervention elements, tools, and outcomes evaluated in this review reflect the diversity of family needs, and that numerous interventions have already been developed to promote family health in critical care settings. The evidence suggests that interdisciplinary nurse-led family interventions can improve family outcomes. Tweetable abstract: Interprofessional nurse-led family interventions draw on diverse approaches and improve family outcomes in adult critical care settings.
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Affiliation(s)
- Frank Kiwanuka
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio 70211, Finland.
| | | | - Yisak Hagos Alemayehu
- Department of Nursing, Adigrat University of Medical and Health Sciences, Adigrat, Ethiopia
| | | | - Tarja Kvist
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio 70211, Finland
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Ardila Suárez EF, Salazar Blandon DA. Percepción sobre actividades de enfermería para satisfacción de necesidades familiares en cuidado intensivo adulto. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2021. [DOI: 10.11144/javeriana.ie23.paes] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Introducción: la satisfacción de las necesidades de la familia en una unidad de cuidado intensivo (UCI) hace parte integral del cuidado del paciente críticamente enfermo y trae beneficios al paciente, la familia y la institución. Objetivo: describir la percepción sobre la frecuencia, pertinencia y viabilidad de actividades de cuidado de enfermería para la satisfacción de las necesidades familiares en UCI. Método: estudio cuantitativo, descriptivo, transversal, realizado a 75 profesionales de enfermería en UCI en un departamento colombiano, mediante muestreo no probabilístico en 11 instituciones hospitalarias de nivel III y IV; la información se recolectó en un periodo de 3 meses, y se aplicó un cuestionario ad hoc diseñado a partir de una revisión integrativa, el cual pasó pruebas por expertos y una prueba piloto; el análisis estadístico se realizó mediante el software SPSS 25.0 y los gráficos mediante el software R, adoptándose como punto de referencia en el análisis una percepción igual o superior al 75 %. Resultados: 75 profesionales de enfermería en UCI perciben que, de las 63 actividades propuestas por el cuestionario, 16 se realizan con mayor frecuencia, 27 son muy pertinentes y 24 muy viables. Conclusiones: según los enfermeros de UCI encuestados, basados en la frecuencia, pertinencia y viabilidad, las actividades de mayor importancia son las de satisfacción de las necesidades de seguridad, seguidas de las de información y proximidad, y finalizando por el apoyo y el confort.
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Damanik SRH, Chen HM. Family needs among patients hospitalized in critical care unit: Scoping review. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [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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Lopez-Soto C, Bates E, Anderson C, Saha S, Adams L, Aulakh A, Bowtell F, Buckel M, Emms T, Shebl M, Metaxa V. The Role of a Liaison Team in ICU Family Communication During the COVID 19 Pandemic. J Pain Symptom Manage 2021; 62:e112-e119. [PMID: 33892123 PMCID: PMC8057931 DOI: 10.1016/j.jpainsymman.2021.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT In the name of public safety, a general suspension on hospital visiting was imposed in the U.K., prohibiting family and friends to visit hospitalized patients, even if they were critically ill. OBJECTIVES we aimed to assess the impact of the FLT on the communication with patients' family and friends (PFF), especailly around end-of-life care, and their interaction with CC clinicians. METHODS A retrospective, mixed-methods analysis of a family liaison team (FLT) formed by redeployed clinicians in critical care (CC) during the first surge of the 2020 COVID 19 pandemic. RESULTS The FLT was constituted predominantly of non-ICU consultants (30/39, 77%). Following two one-hourly webinars around basic communication skills, the FLT facilitated over 12,000 video and telephone calls with 172 patients' family and friends (PFF). The majority of the PFF interviewed were mostly, very or extremely satisfied with the frequency, ease, understanding, honesty, completeness, and consistency of the information provided. Approximately 5% of the interviewees reported to be slightly or very dissatisfied in one or more of the following 3 categories: frequency, consistency, and ease of getting the information. The thematic analysis identified 3 themes: 1) being there with/ for the patient; 2) breakdown in communication; 3) disbelief at the speed of deterioration. In 14.9% of cases there was documented discrepancy between the information transmitted by the CC team and that by the FLT, particularly around the severity of the patient's illness and their imminent death. CONCLUSION The formation of a dedicated FLT was feasible and associated with high levels of satisfaction by the PFF. Friction was created when communication was not consistent and did not convey the severity of the patient's condition, to prepare the PFF for a bad outcome.
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Affiliation(s)
- Carmen Lopez-Soto
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Eleanor Bates
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Charlotte Anderson
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Sian Saha
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Laura Adams
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Alex Aulakh
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Francesca Bowtell
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Marie Buckel
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Thomas Emms
- Ashford & St Peter's Hospital NHS Trust, Ashford, UK
| | - Moustafa Shebl
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
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Voices From the Pandemic: A Qualitative Study of Family Experiences and Suggestions Regarding the Care of Critically Ill Patients. Ann Am Thorac Soc 2021; 19:614-624. [PMID: 34436977 PMCID: PMC8996268 DOI: 10.1513/annalsats.202105-629oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale Intensive care unit (ICU) visitation restrictions during the coronavirus disease (COVID-19) pandemic have drastically reduced family-engaged care. Understanding the impact of physical distancing on family members of ICU patients is needed to inform future policies. Objectives To understand the experiences of family members of critically ill patients with COVID-19 when physically distanced from their loved ones and to explore ways clinicians may support them. Methods This qualitative study of an observational cohort study reports data from 74 family members of ICU patients with COVID-19 at 10 United States hospitals in four states, chosen based on geographic and demographic diversity. Adult family members of patients admitted to the ICU with COVID-19 during the early phase of the pandemic (February–June 2020) were invited to participate in a phone interview. Interviews followed a semistructured guide to assess four constructs: illness narrative, stress experiences, communication experiences, and satisfaction with care. Interviews were transcribed verbatim and analyzed using an inductive approach to thematic analysis. Results Among 74 interviewees, the mean age was 53.0 years, 55% were white, and 76% were female. Physical distancing contributed to substantial stress and harms (nine themes). Participants described profound suffering and psychological illness, unfavorable perceptions of care, and weakened therapeutic relationship between family members and clinicians. Three communication principles emerged as those most valued by family members: contact, consistency, and compassion (the 3Cs). Family members offered suggestions to guide clinicians faced with communicating with physically distanced families. Conclusions Visitation restrictions impose substantial psychological harms upon family members of critically ill patients. Derived from the voics of family members, our findings warrant strong consideration when implementing visitation restrictions in the ICU and advocate for investment in infrastructure (including staffing and videoconferencing) to support communication. This study offers family-derived recommendations to operationalize the 3Cs to guide and improve communication in times of physical distancing during the COVID-19 pandemic and beyond.
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Nakashima H, Gallegos C. Journal Writing by Families of Critically Ill Patients: An Integrative Review. Crit Care Nurse 2021; 40:26-37. [PMID: 33000134 DOI: 10.4037/ccn2020293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Families experience high levels of stress during a loved one's critical illness. OBJECTIVE To provide an overview of current evidence on the use of journal writing as a coping mechanism for family members during a loved one's critical illness in a neonatal, pediatric, or adult intensive care unit. METHODS Five databases (MEDLINE, PsycINFO, CINAHL, APA PsycArticles, and Health Source: Nursing/Academic Edition) were searched to identify studies examining the benefits of journal writing for family members of critically ill patients. Eight eligible studies reported data from 426 relatives of critically ill patients. RESULTS Regarding quality assessment, the quantitative studies met 73.1% of relevant quality criteria, whereas qualitative studies met 81.3%. Mixed-methods studies met 82.4% of quantitative and 55% of qualitative criteria. Various key themes were identified: communication and understanding, connection to the patient, emotional expression, creating something meaningful, and the importance of pictures and staff entries. Overall, writing in a diary seems to be beneficial for reducing psychological distress and posttraumatic stress disorder, but none of the studies found that it significantly decreased anxiety or depression. CONCLUSIONS The findings of this review suggest that having family members of critically ill patients write in a diary is a simple and cost-effective intervention that may improve their psychological outcomes. Critical care nurses are in a position to educate families about the potential benefits of writing in a diary. Future research would be valuable regarding the benefits of using a diary and an optimal approach for doing so in this population.
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Affiliation(s)
- Hannah Nakashima
- Hannah Nakashima is a clinical content specialist, Healthwise, Boise, Idaho. She was a nursing student and research assistant at Boise State University, Boise, Idaho, when this article was written
| | - Cara Gallegos
- Cara Gallegos is an associate professor, Boise State University School of Nursing, Boise, Idaho
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Kynoch K, Ramis MA, McArdle A. Experiences and needs of families with a relative admitted to an adult intensive care unit: a systematic review of qualitative studies. JBI Evid Synth 2021; 19:1499-1554. [PMID: 36521063 DOI: 10.11124/jbies-20-00136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of the review was to synthesize research studies that reported on the experiences and needs of families with a relative in an adult intensive care unit. INTRODUCTION Having a relative in an intensive care unit has been reported to be a time of turmoil, stress, and disruption to the lives of family members. Primary research studies suggest such a crisis or even a planned intensive care unit admission can have not only emotional, physical, and psychological impact, but can also affect family member roles and function. A deeper understanding of the overall experience may assist intensive care unit staff to address specific family needs. INCLUSION CRITERIA This review included qualitative studies of any design that described and explored the experiences and needs of family members with a relative admitted to an adult intensive care unit. METHODS The methods for the review followed the JBI meta-aggregation approach for synthesizing qualitative data. MEDLINE (EBSCO), CINAHL (EBSCO), PsycINFO (EBSCO), Embase (Embase.com) and Web of Science Core Collection (Clarivate Analytics) databases were searched for published studies. ProQuest Dissertations and Theses database (Ovid) was searched for unpublished studies. Studies published from 2010 to November 2019 in the English language were selected for possible inclusion in the review. RESULTS From 7208 citations, 20 studies were agreed upon for inclusion in the review. From these studies, 112 findings were extracted and synthesized into 12 categories. Four synthesized findings were compiled by aggregating the categories. Broadly, these synthesized findings related to: psychosocial health, proximity, information needs, and the intensive care unit environment. CONCLUSIONS Being a relative of a patient in an intensive care unit is a complex, emotional, and individual experience that can have physical, psychological, and emotional impact. The synthesized findings from this review can be used to support family-centered care practices in adult intensive care units, particularly in regard to information provision, visiting practices, and supportive care. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42016053300.
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Affiliation(s)
- Kathryn Kynoch
- Mater Health, Evidence in Practice Unit, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia.,Queensland Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, Brisbane, QLD, Australia
| | - Mary-Anne Ramis
- Mater Health, Evidence in Practice Unit, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia.,Queensland Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, Brisbane, QLD, Australia
| | - Annie McArdle
- Mater Health, Evidence in Practice Unit, Brisbane, QLD, Australia.,Queensland Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, Brisbane, QLD, Australia
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Guáqueta Parada SR, Henao-Castaño ÁM, Motta Robayo CL, Triana Restrepo MC, Burgos Herrera JD, Neira Fernández KD, Peña Almanza BA. Intervenciones de Enfermería ante la Necesidad de Información de la Familia del Paciente Crítico. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Durante el ingreso y permanencia del paciente en la unidad de cuidado intensivo, es imperativo considerar la satisfacción de las necesidades comunicacionales e informativas de la familia del paciente. Objetivo: Integrar los resultados de investigación sobre las intervenciones llevadas a cabo para satisfacer la necesidad de información de las familias de los pacientes en la unidad de cuidado intensivo. Materiales y Métodos: Se realizó una revisión integrativa de estudios en bases de datos Sciencedirect, PubMed, Biblioteca Virtual en Salud y Scielo, con la estrategia de búsqueda [Critical care] and [Needs assessment] and [Family] con criterios de inclusión de estudios publicados entre el año 2009 y el 2019 en idioma inglés, español y portugués disponibles en texto completo Resultados: Después de la lectura analítica de 41 estudios seleccionados se organizaron en 5 temas; uso de folletos de información, sesiones educativas, llamadas telefónicas, uso de tecnologías de la información y comunicación y reuniones familiares. Conclusión: Las intervenciones de enfermería que se han utilizado en la satisfacción de la necesidad de información de la familia son muy variadas e incluyen entre otras los folletos o el uso de TICs, sin embargo la intervención que responde en mayor medida a esta necesidad son las reuniones formales con la familia. Las intervenciones reportadas en los resultados de investigación para responder a la necesidad de información son herramientas clave para que el personal de enfermería las utilice según los recursos con los cuales dispone en su entorno laboral como salas de información para la familia.
Como citar este artículo: Guáqueta Parada Sandra Rocio, Henao Castaño Ángela María, Motta Robayo Claudia Lorena, Triana Restrepo Martha Cecilia, Burgos Herrera Juan David, Neira Fernández Karen Daniela, Peña Almanza Berni Alonso. Intervenciones de Enfermería ante la Necesidad de Información de la Familia del Paciente Crítico. Revista Cuidarte. 2021;12(2):e1775. http://dx.doi.org/10.15649/cuidarte.1775
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Waldemar A, Bremer A, Holm A, Strömberg A, Thylén I. In-hospital family-witnessed resuscitation with a focus on the prevalence, processes, and outcomes of resuscitation: A retrospective observational cohort study. Resuscitation 2021; 165:23-30. [PMID: 34107335 DOI: 10.1016/j.resuscitation.2021.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/21/2021] [Accepted: 05/30/2021] [Indexed: 01/10/2023]
Abstract
AIM International and national guidelines support in-hospital, family-witnessed resuscitation, provided that patients are not negatively affected. Empirical evidence regarding whether family presence interferes with resuscitation procedures is still scarce. The aim was to describe the prevalence and processes of family-witnessed resuscitation in hospitalised adult patients, and to investigate associations between family-witnessed resuscitation and the outcomes of resuscitation. METHODS Nationwide observational cohort study based on data from the Swedish Registry of Cardiopulmonary Resuscitation. RESULTS In all, 3257 patients with sudden, in-hospital cardiac arrests were included. Of those, 395 had family on site (12%), of whom 186 (6%) remained at the scene. It was more common to offer family the option to stay during resuscitation if the cardiac arrest occurred in emergency departments, intensive-care units or cardiac-care units, compared to hospital wards (44% vs. 26%, p < 0.001). It was also more common for a staff member to be assigned to take care of family in acute settings (68% vs. 56%, p = 0.017). Mean time from cardiac arrest to termination of resuscitation was longer in the presence of family (20.67 min vs. 17.49 min, p = 0.020), also when controlling for different patient and contextual covariates in a regression model (Stand(β) 0.039, p = 0.027). No differences were found between family-witnessed and non-family-witnessed resuscitation in survival immediately after resuscitation (57% vs. 53%, p = 0.291) or after 30 days (35% vs. 29%, p = 0.086). CONCLUSIONS In-hospital, family-witnessed resuscitation is uncommon, but the processes and outcomes do not seem to be negatively affected, suggesting that staff should routinely invite family to witness resuscitation.
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Affiliation(s)
- Annette Waldemar
- Department of Cardiology in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, SE-351 95 Växjö, Sweden; Department of Ambulance Service, Kalmar County Council, SE-392 44 Kalmar, Sweden
| | - Anna Holm
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Anna Strömberg
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Ingela Thylén
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden.
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Winarti W, Jadmiko AW. The effect of informational support on anxiety and satisfaction among patients' family members in the emergency room using path analysis. ENFERMERIA CLINICA 2021. [PMID: 33849207 DOI: 10.1016/j.enfcli.2020.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study was to determine the direct and indirect effect of informational support on the levels of anxiety and satisfaction of patients' family members in the ER. A cross-sectional design was used involving 74 family members of patients in an ER. The respondents were selected by way of a purposive sampling technique. The study employed the Hamilton Anxiety Rating Scale (HARS) and a satisfaction questionnaire to collect data. Path analysis was performed on the data analysis. The study findings show that informational support has a more direct (β=0.599) than the indirect effect (β=0.084) on family satisfaction. The results also reveal that informational support has a significant effect on the anxiety score and satisfaction of a patient's family members (p<0.05). The quality and the quantity of informational support affects the levels of anxiety and satisfaction experienced by the family of a patient in the ER.
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Affiliation(s)
- Wiwin Winarti
- Nursing Department, Faculty of Health Science, University of Pembangunan Nasional Veteran Jakarta, Depok, West Java, Indonesia.
| | - Arief Wahyudi Jadmiko
- Nursing Department, Faculty of Health Science, University of Pembangunan Nasional Veteran Jakarta, Depok, West Java, Indonesia
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Amen SS, Berndtson AE, Cain J, Onderdonk C, Cochran-Yu M, Gambles Farr S, Edwards SB. Communication and Palliation in Trauma Critical Care: Impact of Trainee Education and Mentorship. J Surg Res 2021; 266:236-244. [PMID: 34029763 DOI: 10.1016/j.jss.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgical residency training requires Advance Care Planning (ACP) and Palliative Care (PC) education. To meet education needs and align with American College of Surgeons guidelines, our Surgical Intensivists and PC faculty developed courses on communication and palliation for residents (2017-18) and fellows (2018-19). We hypothesized that education in ACP would increase ACP communication and documentation. METHODS The trauma registry of an academic, level 1trauma center was queried for ICU admissions from 2016-2019, excluding incarcerated and pregnant patients. A retrospective chart review was performed, obtaining frequency of ACP documentation, ACP meetings, time from admission to documentation, and PC consultation. We collected ICU quality measures as secondary outcomes: ICU Length Of Stay (LOS), hospital LOS, ventilator days, invasive procedures, discharge disposition, and mortality. Comparisons were made between years prior to (Y 1) and following implementation (Y 2: residents, Y 3: fellows). RESULTS For 1732 patients meeting inclusion criteria, patient demographics, injuries, and injury severity score were comparable. ACP documentation increased from 19.5% in Y 1 to 57.2% in Y 3 (P < 0.001). Time to ACP documentation was reduced from 47.6 to 13.1 h (P < 0.001) from time of admission. ICU LOS decreased from 6 to 4.8 d (P = 0.004). Patients in Y 3 had fewer tracheostomies and percutaneous endoscopic gastrostomies. PC consultations decreased. Mortality was unchanged. CONCLUSION Following trainee education, we observed increases in ACP documentation, earlier communication and improvements in ICU quality measures. Our findings suggest that trainee education positively impacts ACP documentation, reduces LOS, and improves trauma critical care outcomes.
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Affiliation(s)
- Sara S Amen
- Department Of Surgery, California University of Science and Medicine, Colton, California
| | - Allison E Berndtson
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University Of California - San Diego, San Diego, California
| | - Julia Cain
- Doris A. Howell Palliative Teams, University Of California - San Diego, San Diego, California
| | - Christopher Onderdonk
- Doris A. Howell Palliative Teams, University Of California - San Diego, San Diego, California
| | - Meghan Cochran-Yu
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University Of California - San Diego, San Diego, California; Department Of Surgery, Loma Linda University School Of Medicine, Loma Linda, California
| | - Samantha Gambles Farr
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University Of California - San Diego, San Diego, California
| | - Sara B Edwards
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University Of California - San Diego, San Diego, California; Department Of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System and CECORC, Moreno Valley, California.
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Coelho AC, Santos VB, de Barros ALBL. Stressors in intensive cardiac care units: Patients' perceptions. Nurs Crit Care 2021; 27:195-203. [PMID: 33949036 DOI: 10.1111/nicc.12641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) are often admitted to intensive cardiac care units (ICCUs) to have their vital signs and ventricular function monitored. In most cases, they are conscious and bedbound, causing high stress and anxiety levels. AIMS AND OBJECTIVES To assess the stressors affecting patients admitted to ICCUs. DESIGN This is a cross-sectional study performed in a public hospital in São Paulo, Brazil. METHODS A sample of 100 patients with ACS admitted to an ICCU, after 24 hours of hospitalization, was recruited. Sociodemographic and clinical data were collected, and the Intensive Care Unit Stressor Assessment Scale (ICESS) was applied to investigate stressors. The ICESS' internal consistency was estimated by Cronbach's alpha, and the stressors were analysed by descriptive statistics, association tests, and correlation tests. RESULTS Most patients were male, married, and aged 51 to 60 years. The ICESS showed an excellent internal consistency. The mean score identified in patients pointed to a non-stressed to moderately stressed condition. The indicators considered to be more stressful were as follows: "Not knowing ICU length of stay," "Being unable to fulfil family roles," "Missing husband or wife," and "Loss of self-control." CONCLUSIONS Stress levels were considered to be non-stressful to moderately stressful. The main stressors were related to psychological distress and physical discomfort dimensions. RELEVANCE TO CLINICAL PRACTICE Mapping the main stressors of patients with coronary artery disease will allow health professionals to implement strategies to reduce them and consequently reduce their anxiety levels.
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Affiliation(s)
- Aluê Constantino Coelho
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
| | - Vinicius Batista Santos
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
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Kynoch K, Coyer F, Mitchell M, McArdle A. The intensive care unit visiting study: A multisite survey of visitors. Aust Crit Care 2021; 34:587-593. [PMID: 33941440 DOI: 10.1016/j.aucc.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Being able to visit a critically ill relative provides comfort to family members and has recognised benefits to the patient. Limited research has been conducted on demographic characteristics and visiting behaviours of family members with a relative in the intensive care unit (ICU). OBJECTIVES The objective was to provide an overview of local ICU visitor behaviours and practices across four metropolitan units in Australia. METHODS A convenience sample of 440 participants from four ICUs across a metropolitan city in eastern Australia was required for the study. A descriptive 22-item self-report survey was used. Data were collected from four ICUs in a metropolitan city in eastern Australia. Sample characteristics and other variables were analysed using descriptive statistics. RESULTS Data collection was undertaken from April 2018 to May 2019. Four hundred sixty-two (n = 462) ICU visitors responded. There were no significant differences between visitor characteristics across the four hospitals. The mean age of the respondents was 49 years, the youngest participant being 18 years and the oldest being 93 years, with most visitors being women (n = 312, 68%). The participants were more likely to be close relatives such as spouses (n = 117, 25%), parents (n = 113, 24%), or children (n = 79, 17%). Visitors reported different methods by which they received information about visiting policies across units and indicated that they would have visited more frequently if able. Although most respondents rated their ICU visiting experience favourably, some reported being frequently asked to leave the patient's bedside impacted their experience. CONCLUSIONS This study has highlighted that families want to remain in close proximity when they have a relative in the ICU. Despite visiting hours being flexible, most families visit midmorning so that they can talk with staff. Data captured in this study can be used toward improving the ICU visiting experience for family members.
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Affiliation(s)
- Kate Kynoch
- Evidence in Practice Unit, Mater Misericoridae Limited, Raymond Terrace, South Brisbane, QLD, 4101, Australia.
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology (QUT) and Intensive Care Services (ICS), Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, QLD, 4111, Australia
| | - Annie McArdle
- Evidence in Practice Unit, Mater Misericoridae Limited, Raymond Terrace, South Brisbane, QLD, 4101, Australia
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Eltaybani S, Ahmed FR. Family satisfaction in Egyptian adult intensive care units: A mixed-method study. Intensive Crit Care Nurs 2021; 66:103060. [PMID: 33875339 DOI: 10.1016/j.iccn.2021.103060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine family members' satisfaction in adult intensive care units. METHODOLOGY This is mixed-method research. Family members of critically ill patients responded to a structured questionnaire and then were interviewed using semi-structured interviews. Quantitative and qualitative data were analyzed separately and integrated during the discussion. SETTINGS Six adult intensive care units in university hospitals in Egypt. MAIN OUTCOME MEASURES Family satisfaction was assessed using the Critical Care Family Satisfaction Survey and field notes of the interviews. RESULTS The mean total satisfaction score was 12.8 ± 3.5, and comfort has the lowest subscale mean score: 2.07 ± 0.96. Multivariate regression analysis showed that family members' satisfaction was positively associated with their ability to communicate with patients (B [95% confidence interval]: 2.1 [1.19 to 3.02]) and negatively with daily purchasing of medications and supplies (-2.41 [-3.23 to -1.59]), low economic status (-1.57 [-2.47 to -0.67]), and perceiving patient condition to be deteriorating (-0.99 [-1.93 to -0.04]). Content analysis of qualitative data revealed four themes: aspects of family care, aspects of patient care, organizational and administrative issues and environment. CONCLUSIONS In Egyptian adult intensive care units, regular family meetings, flexible visiting hours, shared decision-making, increasing staff-to-patient ratio and ensuring comfortable waiting rooms are promising strategies to enhance family satisfaction.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan; Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Egypt. https://twitter.com/@Sameh_Eltaybani
| | - Fatma Refaat Ahmed
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Egypt; Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
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Abstract
In six weeks the world has changed: COVID-19 - Family-centered care in the intensive care unit Abstract. Background and problem definition: The admission of patients to an intensive care unit is extremely stressful for relatives during the COVID-19 pandemic, as they are not allowed to visit their family members due to a visitation restriction. OBJECTIVES To describe the experience of relatives during the COVID-19 pandemic and to derive support information for health professionals. METHODS Qualitative analysis of three written testimonies of relatives whose family members were hospitalized with COVID-19 or other disease at intensive care unit. RESULTS Relatives report the sudden, unexpected occurrence of the disease. "It was there, out of nowhere, hits the heart of life, doesn't just go away, does what it wants. It is an unknown virus that we have to get to know very closely." The ban on visiting was harsh, it made her faint. The first visit was an indescribable joy. Knowing how the family member was and that the health care professionals were taking professional and empathetic care of the sick person were the only things the relatives could hold on to. DISCUSSION Relatives were reassured when they experienced a high level of commitment on the part of health professionals and received repeated comprehensible information by phone. Limitations and transfer: Restrictions on visits depend on national legislation. Measures such as video calls can also be useful outside of a pandemic to build relationships with relatives.
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Affiliation(s)
| | - Björn Zante
- Universitätsklinik für Intensivmedizin, Inselspital, Bern
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Scharf B, Zhu S, Tomlin S, Cheon J, Mooney-Doyle K, Baggs JG, Weigand D. Feasibility of an Intervention Study to Support Families When Their Loved One Has Life-sustaining Therapy Withdrawn. J Hosp Palliat Nurs 2021; 23:89-97. [PMID: 33284144 PMCID: PMC7903882 DOI: 10.1097/njh.0000000000000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This investigation addressed family member perceptions of preparation for withdrawal of life-sustaining treatment in the intensive care unit. These families are at a high risk for psychosocial and physical sequelae. The quantitative results of this mixed methods study are reported. A control group received usual care and an educational booklet component of the intervention. The experimental group received the above plus exposure to comfort cart items and additional psychological support. Twenty-eight family members enrolled over a 13-month period. Sixty-one percent (10 intervention, 7 control) completed the follow-up. Fourteen family members (82%) recalled the booklet. Some family members reported moderate to severe depression (12.5%), anxiety (12.5%), and stress (12.6%). Satisfaction with care (83.7%-85.2%) and family member well-being (44.1) were within the norm. Short Form-36 physical component score was higher than the norm, and the mental component score was lower than the norm. This study demonstrated feasibility and acceptability of the interventions and follow-up questionnaires when families make the difficult decision to withdraw treatment. Strategies are suggested to strengthen statistical power.
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