Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU:

Experiences of parents visiting an adult family member in the intensive care unit accompanied by their underaged children: A qualitative study

OBJECTIVES

The objective of this study was to explore experiences and needs of parents visiting critically ill family members in intensive care units (ICUs) accompanied by their underaged children (<18 years).

METHODS

Six semistructured interviews with parents were conducted in a qualitative design. Data analysis and synthesis were performed using Braun and Clarke's thematic analysis. This study was conducted in five adult ICUs in Switzerland.

FINDINGS

Parents opted for early and truthful involvement of their children, and the majority initiated the visits themselves. Five themes were identified: feeling of shock by the entire family; crying in front of the children; feeling welcome with the children; knowing that the children can cope with it; and holding the family together. Parents felt only partially welcomed in the ICU when accompanied by their children. In one case, the parents withdrew the child from the visit.

CONCLUSIONS

Parents experienced the visit to a critically ill family member in the ICU with their underaged children as challenging. They were emotionally vulnerable and yet took the initiative to keep the family together. Parents had to mediate between their children, the critically ill family member, and the treatment team. Awareness of the needs of the parents visiting with underaged children is important in clinical practice. There is a need for family-centred structures and processes, including adequate visiting times and rooms suitable for children with books, pictures, and toys.

Implementation of a digital diary in the intensive care unit; understanding the facilitators and barriers: A qualitative exploration

BACKGROUND

In the recent years, digital intensive care unit (ICU) diaries have emerged as more advantageous than paper diaries. Despite the advantages of digital diaries, the successful implementation and maintenance of this digital intervention present significant challenges in clinical practice. Therefore, understanding the facilitators and barriers among stakeholders influencing this process becomes imperative for devising a tailored strategy to integrate digital diaries effectively within ICU settings.

AIM/OBJECTIVE

The aim of this study was to explore facilitators and barriers for implementation of a digital ICU diary from the perspectives of ICU professionals, ICU survivors, and their relatives.

METHODS

A qualitative design was used, incorporating focus-group interviews with professionals from four Dutch ICUs, along with individual interviews with ICU survivors and relatives. The study spanned from October 2022 to April 2023. Data analysis utilised a mixed inductive-deductive approach, particularly through directed content analysis. The Consolidated Framework for Implementation Research 2.0 guided both data collection and analysis processes.

FINDINGS

We conducted five focus-group interviews among ICU professionals (n = 32) and 10 individual or dual interviews involving five ICU survivors and nine relatives. Key facilitators for implementing a digital diary according to ICU professionals encompassed a user-friendly interface accessible independent of time and place, with a seamless login process requiring minimal steps, comprehensive training covering all aspects of its use, and feedback from the experiences of both patients and relatives. Barriers for ICU professionals included many steps required to access the digital diary, as well as resistance to (co)writing diary entries. In contrast, professionals' involvement in writing diary entries was highly appreciated among ICU survivors and relatives. An ambiguous factor arose regarding sharing the digital diary with others; both ICU survivors and relatives found it valuable, yet it also raised privacy concerns.

CONCLUSIONS

This study offers insights into the most important factors influencing the implementation of a digital ICU diary. Strikingly, some factors serve as both barriers and facilitators. When developing the implementation strategy, the identified facilitators can be used to overcome the barriers faced by ICU professionals, ICU survivors, and their relatives in adopting a digital diary.

Families as partners in neonatal neuro-critical care programs

Parents of neonates with neurologic conditions face a specific breadth of emotional, logistical, and social challenges, including difficulties coping with prognostic uncertainty, the need to make complex medical decisions, and navigating new hopes and fears. These challenges place parents in a vulnerable position and at risk of developing mental health issues, which can interfere with bonding and caring for their neonate, as well as compromise their neonate's long-term neurodevelopment. To optimize neurologic and developmental outcomes, emerging neonatal neuro-critical care (NNCC) programs must concurrently attend to the unique needs of the developing newborn brain and of his/her parents. This can only be accomplished by embracing a family-centered care environment-one which prioritizes effective parent-clinician communication, longitudinal parent support, and parents as equitable partners in clinical care. NNCC programs offer a multifaceted approach to critical care for neonates at-risk for neurodevelopmental impairments, integrating expertise in neonatology and neurology. This review highlights evidence-based strategies to guide NNCC programs in developing a family-partnered approach to care, including primary staffing models; staff communication, implicit bias, and cultural competency trainings; comprehensive and tailored caregiver training; single-family rooms; flexible visitation policies; colocalized neonatal and maternal care; uniform mental health screenings; follow-up care referrals; and connections to peer support. IMPACT: Parents of neonates with neurologic conditions are at high-risk for experiencing mental health issues, which can adversely impact the parent-neonate relationship and long-term neurodevelopmental outcomes of their neonates. While guidelines to promote families as partners in the neonatal intensive care unit (NICU) have been developed, no protocols integrate the unique needs of parents in neonatal neurologic populations. A holistic approach that makes families true partners in the care of their neonate with a neurologic condition in the NICU has the potential to improve mental and physical well-being for both parents and neonates.

Delirium and Coronavirus Disease 2019: Looking Back, Moving Forward

During the coronavirus disease 2019 pandemic, crisis changes in clinical care increased rates of delirium in the intensive care unit (ICU). Deep sedation, unfamiliar environments with visitor restrictions, and such factors due to high workload and health system strain contributed to the occurrence of delirium doubling in the ICU. As the pandemic wanes, health care systems and ICU leadership must emphasize post-pandemic recovery, integrating lessons learned about delirium management, evidence-based care, and family involvement. Strategies to empower clinicians, creatively deliver care, and integrate families pave the way forward for a more holistic approach to patient care in the post-pandemic era.

[Ethical aspects in the context of extracorporeal life support systems (ECLS): consensus paper of the DGK, DGTHG and DGAI]

Extracorporeal life support systems (ECLS) are life-sustaining measures for severe cardiovascular diseases, serving as bridging treatment either until cardiovascular function is restored or alternative treatment, such as heart transplantation or the implantation of permanent ventricular assist devices is performed. Given the insufficient evidence and frequent urgency of implantation without initial patient consent, the ethical challenges and psychological burden for patients, relatives and the interprofessional intensive care team are significant. As with any treatment, an appropriate therapeutic goal for ECLS treatment based on the indications and patient informed consent is mandatory. In order to integrate the necessary ethical considerations into everyday clinical practice, a structured algorithm for handling ECLS is proposed here, which takes ethical aspects into due account.

The parent perspective on paediatric delirium and an associated care bundle: A qualitative study

AIMS

To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle.

DESIGN

We conducted a qualitative exploratory descriptive study using semi-structured individual or dyad interviews.

METHODS

Twelve semi-structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis.

FINDINGS

We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long-term consequences, (4) adding insight to the bundle, and (5) family engagement.

CONCLUSION

The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium.

IMPACT

This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit.

REPORTING METHOD

The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution to the research design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL COMMUNITY?: - It increases awareness of the parent's perspective on PD in critically ill children. - It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage. - It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child.

Mothers' experiences of privacy in neonatal intensive care units: A qualitative study

BACKGROUND

Examining the privacy experiences of mothers in neonatal intensive care units (NICUs) can play a crucial role in bolstering patient privacy safeguards and elevating the overall quality of health care. However, our understanding of mothers' experiences regarding privacy issues they may face after their infants' hospitalization in the NICU is limited.

AIM

This study aimed to investigate the experiences of mothers concerning privacy within NICUs to contribute valuable insights for improving infant care and privacy protection.

DESIGN

A qualitative content analysis using a conventional approach was conducted. A total of 18 participants, with diverse sociodemographic backgrounds, were interviewed using open-ended questions. Qualitative content analysis was undertaken for data analysis.

SETTING

The study was conducted in the NICU of an urban teaching hospital in Iran.

RESULTS

The study identified four main themes: 'understanding of privacy', 'fluctuating respect for privacy', 'efforts to maintain privacy' and 'privacy barriers'. Participants viewed privacy as multidimensional, influenced by cultural and religious factors. Respect for privacy varied, with instances of both adherence and violation. Mothers employed strategies to preserve privacy, emphasizing the importance of their infants' privacy. Privacy barriers included hospital attire, the physical space of the NICU, inhomogeneous human resources and insufficient supervision and training.

CONCLUSION

This study, the first of its kind in the NICU context, provides valuable insights into maternal experiences of privacy. Integrating these insights into practice and future research can contribute to creating more empathetic and privacy-respecting NICU environments.

RELEVANCE TO CLINICAL PRACTICE

Health care providers can use these findings to enhance support for mothers, potentially reshaping physical spaces and communication practices within NICUs.

Supporting families during pediatric critical illness: Opportunities identified in a multicenter, qualitative study

Critical illness resulting in a pediatric intensive care unit (PICU) admission is a profoundly stressful experience for a child and their family. Increasing evidence for emotional and behavioral sequelae post-PICU emphasizes a need to provide better support for families throughout this period of care and recovery. The aim of this qualitative investigation was to identify salient and modifiable aspects of a critical care experience that can be addressed to better support families of critically ill children. Individual semi-structured interviews were conducted with 26 caregivers of children who survived a PICU admission. Interviews were audio-recorded and transcribed verbatim; themes were identified via thematic analysis. Caregivers were enrolled using convenience sampling from seven tertiary care PICUs in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Themes from caregiver interviews were identified within two overarching categories containing three themes each. Advice for future PICU families: (1) Be intentional about caring for your own well-being, (2) speak up, ask questions, and challenge decisions you're not comfortable with, and (3) continue to engage with your child. Characteristics of a satisfactory PICU experience: (1) A caregiver-provider relationship of mutual trust established through clear communication and respectful collaboration, (2) hospital environments that provide physical and social supports to maintain humanity in healthcare, and (3) preparing families for care transitions. Targeted, interdisciplinary approaches to partner with families during critical care may improve their PICU experience and contribute to improved long-term outcomes for PICU survivors.

Multicomponent family support intervention in intensive care units: statistical analysis plan for the cluster-randomized controlled FICUS trial

The FICUS trial is a cluster-randomized superiority trial to determine the effectiveness of a nurse-led, interprofessional family support intervention (FSI) on the quality of care, family management and individual mental health of family members of critically ill patients, compared to usual care. This paper describes the statistical analysis plan of the FICUS trial. The primary outcome is quality of family care, assessed by the Family Satisfaction in ICU Questionnaire (FS-ICU-24R) at patient discharge from the ICU. Several secondary outcomes are additionally assessed 3, 6, and 12 months thereafter. Sixteen clusters (ICUs) were randomly assigned 1:1 to FSI or usual care using minimization (8 per treatment). The target sample size is 56 patients per cluster (896 in total). Recruitment has been completed in January 2024. The follow-up of the last participant will be completed in early 2025. The primary and secondary outcomes will be analyzed by linear mixed-effects models (LMM). The main model for the primary outcome will include a random intercept per cluster with treatment (FSI vs. usual care) as the only explanatory variable due to the relatively small number of clusters. In addition, covariate-adjusted analyses will be conducted, including two cluster-level characteristics used in the minimization as well as participant-level characteristics. Moreover, a number of subgroup analyses by cluster- and participant-level characteristics are pre-specified.Trial registration ClinicalTrials.gov NCT05280691 . Registered on February 20, 2022.

Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review

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 .

Navigating the shadows: medical professionals' values and perspectives on end-of-life care within pediatric intensive care units in Croatia

Background and aim

This study explores healthcare professionals' perspectives on end-of-life care in pediatric intensive care units (ICUs) in Croatia, aiming to illuminate their experiences with such practices, underlying attitudes, and major decision-making considerations. Amid the high variability, complexity, and emotional intensity of pediatric end-of-life decisions and practices, understanding these perspectives is crucial for improving care and policies.

Methods

The study utilized a cross-sectional survey intended for physicians and nurses across all pediatric ICUs in Croatia. It included healthcare professionals from six neonatal and four pediatric ICUs in total. As the data from neonatal and pediatric ICUs were examined jointly, the term pediatric ICU was used to denominate both types of ICUs. A statistical analysis was performed using Python and JASP, focusing on professional roles, professional experience, and regional differences.

Results

The study included a total of 103 participants (with an overall response rate-in relation to the whole target population-of 48% for physicians and 29% for nurses). The survey revealed diverse attitudes toward and experiences with various aspects of end-of-life care, with a significant portion of healthcare professionals indicating infrequent involvement in life-sustaining treatment (LST) limitation discussions and decisions, as well as somewhat ambiguous attitudes regarding such practices. Notably, discrepancies emerged between different professional roles and, in particular, regions, underscoring the high variability of LST limitation-related procedures.

Conclusions

The findings highlight a pressing need for more straightforward guidelines, legal frameworks, support mechanisms, and communication strategies to navigate the complex terrain of rather burdensome end-of-life pediatric care, which is intrinsically loaded with profound ethical quandaries.

Child and Family Outcomes and Experiences Related to Family-Centered Care Interventions for Hospitalized Pediatric Patients: A Systematic Review

BACKGROUND/OBJECTIVES

Family-centered care (FCC) is the recommended model for pediatric inpatient care. Our overall aim was to conduct a narrative synthesis of the contemporary published research on the effectiveness of FCC interventions for pediatric inpatients. Our specific objective was to critique studies of inpatient pediatric FCC interventions that evaluated child or parent outcomes.

METHODS

We searched five databases (Pubmed, CINAHL, Embase, PsychInfo, and Web of Science) for peer-reviewed research published from 1 January 2017 to 6 February 2024. Independent reviewers evaluated each study based on pre-specified inclusion and exclusion criteria, then extracted and narratively synthesized the data.

RESULTS

We found 16 studies of 15 interventions conducted in six countries. The studies were quantitative (n = 11), qualitative (n = 3), and mixed methods (n = 2), with most designs being of low to moderate quality based on a modified Mixed-Methods Appraisal Tool. Interventions included family-centered rounds, parent-focused health information technology, education, patient navigation, parent-peer support, partnership, and parent participation in caregiving. Most studies found significant improvements in parents' well-being, knowledge, and participation, as well as decreased stress and anxiety with the FCC interventions compared to usual care. One study found no differences in child outcomes (infant feeding, length of stay) between usual care and a parent-participation intervention.

CONCLUSIONS

Although FCC interventions led to many improved outcomes for parents, there were few well-designed comparison studies using validated tools and well-defined interventions. Higher quality research is needed to promote greater uptake and sustainability of FCC interventions globally.

Effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit: A randomized controlled trial

OBJECTIVE

To examine the effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit.

DESIGN

Prospective randomized controlled parallel-group clinical trial.

SETTING

Maternal and Child Health Hospital, Fujian, China.

METHODS

The control group received routine neonatal intensive care unit care, while the intervention group received a web neonatal intensive care unit diary based on routine care. Outcomes, including anxiety, depression, and post-traumatic stress disorder symptoms, quality of life, sleep quality, care ability, and cortisol and melatonin levels, were evaluated at T1 (Time 1, before the intervention), T2 (Time 2, immediately after the intervention), and T3 (Time 3, 1 month after the intervention).

RESULTS

Seventy pairs of parents of preterm infants in the neonatal intensive care unit were randomly allocated to two groups: intervention (n = 35) and control (n = 35). The anxiety scores in the intervention group were significantly lower at T2 and T3 than those in the control group (P < 0.001). The care ability scores in the intervention group were significantly higher at T2 and T3 (P < 0.001). The prevalence of post-traumatic stress disorder at T3 was significantly different between the groups (P = 0.040). No significant differences were observed in the quality of life or sleep quality between the groups at T2 and T3 (P > 0.05). No significant differences were observed in cortisol and melatonin levels between the groups (P > 0.05).

CONCLUSIONS

Web neonatal intensive care unit diaries effectively relieved anxiety symptoms, reduced the prevalence of post-traumatic stress disorder, and enhanced the care abilities of parents of preterm infants in the neonatal intensive care unit.

IMPLICATIONS FOR CLINICAL PRACTICE

Web neonatal intensive care unit diary can be considered in clinical practice as a convenient psychological intervention method, especially among parents of preterm infants in the neonatal intensive care unit.

Patient-centered care for mental health in patients with heart failure in the intensive care unit: A systematic review

AIM

To assess basic data for developing appropriate interventions by examining the effects of patient-centered care (PCC) on the mental health of patients with heart failure in the intensive care unit (ICU).

BACKGROUND

Patients with heart failure are frequently admitted to ICUs, and ICU stays are associated with prolonged mental health problems.

METHODS

We conducted a systematic review using the CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, and gray literature databases. Inclusion criteria were studies with participants aged ≥18 years with heart failure in the ICU who received a PCC intervention, and studies that described the outcomes for mental health problems. Data were extracted from five selected studies published after 2020 and analyzed.

RESULTS

PCC is classified into three areas: comprehensive nursing, multidisciplinary disease management, and targeted motivational interviewing with conventional nursing. The two specific areas of focus for PCC regarding mental health were integrated mental healthcare and specific psychological nursing. Specific psychological nursing comprised relationship building, therapeutic communication, relaxation and motivational techniques, active therapeutic cooperation, psychological status evaluation, music therapy, and environmental management.

CONCLUSIONS

This review provides a distinctive understanding of multidisciplinary and multicomponent PCC interventions for patients with heart failure in the ICU as an effective approach for improving their mental health. Future PCC intervention strategies aimed at patients with heart failure in the ICU should consider their preferences and family participation.

Paediatrics and discomfort with death and dying

Death and dying, while uncommon in day-to-day paediatrics practice, are becoming increasingly common occurrences as children with life-limiting illnesses are living longer. We reflect on our experiences with death and dying in our residency training and whether paediatrics, as a specialty, is uncomfortable with death. Paediatric trainees should be included in honest discussions about disease trajectories and participate in providing end-of-life care. Anticipatory guidance helps personalize care and can prevent unnecessary procedures or suffering that patients may experience. While trainees may not be present at the end-of-life for many patients, managing death and dying are important competencies for future paediatricians. Current paediatricians should reflect on their comfort with death and how this may impact their patient care.

Virtual Patient and Family Engagement Strategies in Critical Care: A Scoping Review

Background: Family engagement in care is increasingly recognized as an essential component of optimal critical care delivery. However, family engagement strategies have traditionally involved in-person family participation. Virtual approaches to family engagement may overcome barriers to family participation in care. The objective of this study was to perform a scoping review of virtual family engagement strategies in the intensive care unit (ICU). Methods: Studies were included if they involved a virtual engagement strategy with family members of an ICU patient and reported either (1) outcomes, (2) user perspectives, and/or (3) barriers or facilitators to virtual engagement in the ICU. Study types included primary research studies and review articles. Study selection followed the Joanna Briggs Institute Methodology for Scoping Reviews guidelines without any cultural, ethnic, gender, or specific language restrictions. The source of evidence included Ovid MEDLINE, PubMed, CINAHL, and Cochrane Library databases from inception to November 17, 2023. Google scholar was searched on December 1, 2023. Data were extracted on virtual engagement strategy used, outcomes (patient-centered, family-centered, and clinical), perspectives (patient, family, and health care professional [HCP]), and reported barriers or facilitators to virtual engagement in the ICU. Results were categorized into adult or pediatric/neonatal ICU setting. Results: Virtual engagement strategies identified were virtual visitation, virtual rounding, and virtual meetings. Family and HCPs were generally supportive of virtual visitation and rounding strategies. Overall, virtual strategies were associated with improved patient, family, and HCP outcomes. There were a few randomized interventional studies evaluating the effectiveness of virtual engagement strategies. Family, HCP, technological, and institutional barriers to the implementation and conduct of virtual engagement strategies were reported. Conclusions: Virtual family engagement strategies are associated with improved outcomes for patients, family, and HCPs. Identified barriers to virtual family engagement should be addressed. Future studies are needed to evaluate the effectiveness of virtual family engagement strategies in a more rigorous manner.

A Case Report and Review of the Literature of ICU Delirium

This case report focuses on what patients and family members may experience when a neurological trauma transpires and resultant intensive care (ICU) delirium occurs. It is the personal account of the patient (A.B.) and spouse's (R.G.B.) perspectives when the patient (A.B) suffered a vertebral artery aneurysm and hemorrhage and experienced intensive care unit (ICU) delirium after being in the ICU for 22 days. This case report provides the patient's and spouse's perspectives regarding delirium, i.e., A.B.'s inability to discern reality, loss of memory, paranoia and hallucinations, agency and recovery, post-ICU syndrome, and post-traumatic stress disorder (PTSD). Clinical diagnosis by the neurosurgeon indicated delirium, with treatment consisting of sleep sedation and uninterrupted sleep. A.B. was able to regain consciousness yet experienced post-traumatic stress disorder up to one year afterward. Consistent family participation in the patient's delirium care is crucial. Family member care and family-centered strategies are provided with implications for future research and health care.

Impact of a family support intervention on hospitalization costs and hospital readmissions among ICU patients at high risk of death or severe functional impairment

BACKGROUND

Patients with advanced critical illness often receive more intensive treatment than they would choose for themselves, which contributes to high health care costs near the end of life. The purpose of this study was to determine whether a family support intervention delivered by the interprofessional ICU team decreases hospitalization costs and hospital readmissions among critically ill patients at high risk of death or severe functional impairment.

RESULTS

We examined index hospitalization costs as well as post-discharge utilization of acute care hospitals, rehabilitation and skilled nursing facilities, and hospice services for the PARTNER trial, a multicenter, stepped-wedge, cluster randomized trial of an interprofessional ICU family support intervention. We determined patients' total controllable and direct variable costs using a computerized accounting system. We determined post-discharge resource utilization (as defined above) by structured telephone interview at 6-month follow-up. We used multiple variable regression modelling to compare outcomes between groups. Compared to usual care, the PARTNER intervention resulted in significantly lower total controllable costs (geometric mean: $26,529 vs $32,105; log-linear coefficient: - 0.30; 95% CI - 0.49, - 0.11) and direct variable costs ($3912 vs $6034; - 0.33; 95% CI - 0.56, - 0.10). A larger cost reduction occurred for decedents ($20,304 vs. $26,610; - 0.66; 95% CI - 1.01, - 0.31) compared to survivors ($31,353 vs. $35,015; - 0.15; 95% CI - 0.35,0.05). A lower proportion in the intervention arm were re-admitted to an acute care hospital (34.9% vs 45.1%; 0.66; 95% CI 0.56, 0.77) or skilled nursing facility (25.3% vs 31.6%; 0.63; 95% CI 0.47, 0.84).

CONCLUSIONS

A family support intervention delivered by the interprofessional ICU team significantly decreased index hospitalization costs and readmission rates over 6-month follow-up. Trial registration Trial registration number: NCT01844492.

Family Satisfaction of Polytrauma Patients in Intensive Care Unit at a Tertiary Care Center

BACKGROUND

Family members play a crucial role in ICU patients' treatment and decision-making, despite the stress and uncertainty they may experience, ensuring high-quality medical care. Providing comfortable spaces with noise-reducing techniques can boost family satisfaction. Further research is needed to support families in intensive care units (ICU). This study aims to evaluate family satisfaction and decision-making in polytrauma patients in the ICU, identify improvement opportunities, and analyze demographic and socioeconomic factors influencing satisfaction.

METHODS

This cross-sectional study was conducted at King George's Medical University, Lucknow, over a period of one year. A total of 66 patients, aged between 20 and 70, their family members, and those who gave written informed consent were included. Exclusion criteria included those who died within 48 hours of ICU admission or did not give consent. Patient characteristics, such as age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and hospital stay length, were also collected. The family satisfaction in the intensive care unit (FS-ICU) questionnaire, consisting of 24 items with five Likert response options, was used to assess satisfaction levels in ICU care and decision-making.

RESULTS

 A study of 66 patients which included 78.79% male and 21.21% female. The majority of the patients (66.67%) lived with their family members. The mean ICU stay was 13.03 days, with an APACHE score of 17.39. The results showed that families were very satisfied with a considerable portion of the ICU stay. The overall satisfaction score was 57.00. Families were less satisfied with the atmosphere in the ICU and involvement in the decision-making process. The satisfaction scores were comparable for both genders, except for the time taken to respond to questions, which was significantly higher for women.

CONCLUSION

Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The present study shows that the quality of treatment and communication during hospitalization is a major factor in the need for follow-up care. This underlines the need for a constant focus on communication skills in the training of nurses and doctors and in their practical training in the ICU. Participation in decision-making, especially by family members of survivors, was identified as an area for improvement. We recommend more research to be conducted in India focusing on family satisfaction with involvement in the decision-making in ICU considering the unique racial, cultural, ethnic, and linguistic differences in India.

Nurses' practices of children and family-centered care for chronically ill children: A cross-sectional study

PURPOSE

There is limited evidence of children and family-centered care (CFCC) practice in different cultural contexts, particularly regarding the factors that predict it among nurses providing care to chronically ill children. Also, the CFCC's impact on the quality of care has not been well studied. This study aimed to test a hypothesized model in which nurses' attributes and care environments predict CFCC, thereby increasing the quality of nursing care.

DESIGN AND METHODS

A multicenter cross-sectional study recruited a convenience sample of 405 nurses caring for chronically ill children in Saudi Arabia for an online survey between February 2023 and August 2023. Structural Equation Modeling evaluated the hypothesized model.

RESULTS

The hypothesized model fits the data based on the fit indices. Care environment affected CFCC (β = 0.831, p = .000), while nursing attributes only indirectly affected CFCC practices through the mediating effect of the work environment (β = 0.553, p = .000). The CFCC practices positively affect the quality of nursing care (β = 0.636, p = .000).

CONCLUSIONS

Nursing attributes impact the work environment, which affects the practice of CFCC and enhances the quality of care for chronically ill children. Investing in nurses' attributes and a positive work environment is crucial for nursing leaders to enhance CFCC practice and the quality of care.

PRACTICAL IMPLICATIONS

The findings of this study can be used to shape policies and develop interventions to improve nursing CFCC practices and promote better quality of care for chronically ill children.

An Exploration of the Supportive Care Needs of Caribbean Families of Critically Ill Adults

ABSTRACT

Nurses care for patients of diverse cultures. Persons in and from the Caribbean region have specific needs and concerns related to the support they need when a family member is admitted to an intensive care unit (ICU). Nurses familiar with Caribbean patient culture can provide these family members with knowledgeable and culturally competent care. However, little research exists about the unique needs of this population. This pilot study explored the nursing support needs of adult Caribbean family members of patients in the ICU.

Factors Associated With Quality-of-Dying-and-Death Classes Among Critically Ill Patients

Importance

Improving end-of-life care in the intensive care unit (ICU) is a priority, but clinically modifiable factors of quality of dying and death (QODD) are seldom identified.

Objectives

To comprehensively identify factors associated with QODD classes of dying ICU patients, emphasizing clinically modifiable factors based on the integrative framework of factors associated with for bereavement outcomes.

Design, Setting, and Participants

This observational cohort study was conducted at medical ICUs of 2 Taiwanese medical centers from January 2018 to March 2020 with follow-up through December 2022. Eligible participants included primary family surrogates responsible for decision making for critically ill ICU patients at high risk of death (Acute Physiology and Chronic Health Evaluation II score >20) but who survived more than 3 days after ICU admission. Data analysis was conducted from July to September 2023.

Main Outcomes and Measures

QODD was measured by the 23-item ICU-QODD questionnaire. Factors associated with patient membership in 4 previously determined QODD classes (high, moderate, poor to uncertain, and worst) were examined using a 3-step approach for latent class modeling with the high QODD class as the reference category.

Results

A total of 309 family surrogates (mean [SD] age, 49.83 [12.55] years; 184 women [59.5%] and 125 men [40.5%]) were included in the study. Of all surrogates, 91 (29.4%) were the patients' spouse and 66 (53.7%) were the patients' adult child. Patient demographics were not associated with QODD class. Two family demographics (age and gender), relationship with the patient (spousal or adult-child), and length of ICU stay were associated with QODD classes. Patients of surrogates perceiving greater social support were less likely to be in the poor to uncertain (adjusted odds ratio [aOR], 0.89; 95% CI, 0.83-0.94) and worst (aOR, 0.92; 95% CI, 0.87-0.96) QODD classes. Family meetings were associated with the poor to uncertain QODD class (aOR, 8.61; 95% CI, 2.49-29.74) and worst QODD class (aOR, 7.28; 95% CI, 1.37-38.71). Death with cardiopulmonary resuscitation was associated with the worst QODD class (aOR, 7.51; 95% CI, 1.12-50.25). Family presence at patient death was uniformly negatively associated with the moderate QODD class (aOR, 0.16; 95% CI, 0.05-0.54), poor to uncertain QODD class (aOR, 0.21; 95% CI, 0.05-0.82), and worst QODD class (aOR, 0.08; 95% CI, 0.02-0.38). Higher family satisfaction with ICU care was negatively associated with the poor to uncertain QODD class (aOR, 0.93; 95% CI, 0.87-0.98) and worst QODD class (aOR, 0.86; 95% CI, 0.81-0.92).

Conclusions and Relevance

In this cohort study of critically ill patients and their family surrogates, modifiable end-of-life ICU-care characteristics played a more significant role in associations with patient QODD class than did immutable family demographics, preexisting family health conditions, patient demographics, and patient clinical characteristics, thereby illuminating actionable opportunities to improve end-of-life ICU care.

Effectiveness and family experiences of interventions promoting partnerships between families and pediatric and neonatal intensive care units: a mixed methods systematic review

OBJECTIVE

The objective of this mixed methods review was to examine the effectiveness and family experiences of interventions promoting partnerships between families and the multidisciplinary health care team in pediatric and neonatal intensive care units.

INTRODUCTION

Hospitalization of infants and children in neonatal intensive care units and pediatric intensive care units has a significant effect on their families, including increased stress, anxiety, and depression. Available evidence syntheses focused on specific family-centered care, but not on partnership, which is another aspect that may improve families' outcomes and experiences.

INCLUSION CRITERIA

This review considered studies that focused on effectiveness or family experiences of interventions by health professionals in partnership with families of infants or children hospitalized in an intensive care unit. For the quantitative component of the review, the type of intervention was a partnership between the health care team and the family, and focused on outcomes of stress, anxiety, depression, quality of life, attachment, or satisfaction with family-centered care. For the qualitative component, the phenomenon of interest was family experiences of interventions that included collaboration and partnering with the health care team in the pediatric or neonatal intensive care unit. Quantitative, qualitative, and mixed methods studies, published from 2000 to August 2022 in English or French, were eligible for inclusion.

METHODS

The JBI methodology for convergent segregated mixed methods systematic reviews was followed using the standardized JBI critical appraisal and data extraction tools. Ten databases were searched in December 2019 and again in August 2022. Study selection, critical appraisal, and data extraction were performed by 2 reviewers independently. Findings of quantitative studies were statistically pooled through meta-analysis and those that could not be pooled were reported narratively. Qualitative studies were pooled through meta-synthesis.

RESULTS

This review included 6 qualitative and 42 quantitative studies. The methodological quality varied, and all studies were included regardless of methodological quality. Meta-analyses showed improvements in anxiety, satisfaction with family-centered care, and stress, yet no conclusive effects in attachment and depression. These results should be interpreted with caution due to high heterogeneity. Qualitative analysis resulted in 2 synthesized findings: "Interventions that incorporate partnerships between families and the health care team can improve the family's experience and capacity to care for the child" and "Having a child in intensive care can be an experience of significant impact for families." Integration of quantitative and qualitative evidence revealed some congruence between findings; however, the paucity of qualitative evidence minimized the depth of this integration.

CONCLUSIONS

Partnership interventions can have a positive impact on parents of children in intensive care units, with improvements reported in stress, anxiety, and satisfaction with family-centered care.

REVIEW REGISTRATION

PROSPERO CRD42019137834.

SUPPLEMENTAL DIGITAL CONTENT

A Chinese-language version of the abstract of this review is available at http://links.lww.com/SRX/A50 . A French-language version of the abstract of this review is available at http://links.lww.com/SRX/A51 .

Understanding family-centered care in the NICU: a scoping review protocol

OBJECTIVE

This scoping review will aim to identify and categorize the definitions of neonatal intensive care unit (NICU) family-centered care (FCC) and its associated concepts. It also aims to identify and categorize the practices and interventions that comprise NICU FCC, and catalog the metrics used to evaluate NICU FCC.

INTRODUCTION

FCC has been identified as an important element of care for neonates and infants admitted to the NICU, and there is clear evidence that the incorporation of families in care improves clinical outcomes. However, FCC has been linked to numerous associated terms and concepts and lacks a unifying definition or framework, thus limiting the ability to categorize, prioritize, and identify practices and interventions to optimize both institutional approaches for individual centers and for the field at large.

INCLUSION CRITERIA

Studies that include or apply at least one FCC concept or its associated terms will be considered eligible for inclusion. Studies not related exclusively to the NICU will be excluded.

METHODS

The review will follow the JBI methodology for scoping reviews and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Several electronic databases and sources of gray literature will be searched from 1992 to the present day. The review will include only full-text studies in English and will be independently screened by a minimum of 2 authors. Data will be extracted using a modified JBI data extraction tool and presented using narrative summaries; concept mapping; and categorization of practices, interventions, and metrics.

The Why and How of Family-Centered Care

Although the Accreditation Council for Graduate Medical Education states that neonatal-perinatal medicine fellows must demonstrate an understanding of the emotional impact of admission to the NICU on a family, few curricula are in place to teach this important competency. Family-centered care (FCC) in the NICU is an approach to health care that focuses on decreasing mental and emotional trauma for families while empowering them to reclaim their role as caregivers. FCC is deeply rooted in trauma-informed care and is crucial during transition periods throughout the NICU admission. In this article, we provide a review of FCC and trauma-informed care and how to use these approaches at different stages during an infant's hospitalization. We also discuss parent support networks and how to integrate FCC into an existing NICU practice.

A Qualitative Study to Explore the Nurses' Experience of Writing Caring Notes in Diaries for Extracorporeal Oxygenation Membrane (ECMO) Patients: Explore the nurse's experience

The use of diaries is known to reduce post-intensive care syndrome in the intensive care unit (ICU) for survivors and families. Studies are needed to explore nurses' experience with diaries. Although the diaries are written for the patient, the diary entries may be helpful for the nurse as well. Research has shown that ICU diaries fill in significant memory gaps and aid in the resolution of delusional memories. However, there is a shortage of knowledge about the nurses' experience of writing caring notes in diaries. The purpose of this research was to explore the extracorporeal membrane oxygenation (ECMO) nurses' experience of writing caring notes in diaries during the patients' ICU stay. This is a descriptive phenomenological qualitative research study using semi-structured interviews. A one-on-one interview was performed, audiotaped, and transcribed. Three investigators analyzed the data for themes, subcategories, and indicators. A purposive sample of 15 specialty-trained ECMO nurses participated in the study. Three themes emerged from the study relating to the nurse, family, and patient, including positive and negative aspects of writing in the diary and barriers. The vast majority (88%) of 340 comments answered during the interviews were positive. Overall, nurses found the diaries to be beneficial to the nurse, family, and patient. Diary writing may help nurses get back to the core of why we do what they do. Understanding the nurses' experience may help to improve communication and family satisfaction while optimizing dairy programs.

An Approach to Caring for Patients and Family of Patients Dying in the ICU

TOPIC IMPORTANCE

Death is common in the ICU and often occurs after a decision to withhold or withdraw life-sustaining therapies. Care of the dying is a core skill for ICU clinicians, requiring expert communication, primarily with family of critically ill patients.

REVIEW FINDINGS

Limited high-quality evidence supports specific practices related to the care of dying patients in the ICU; thus, many of the recommendations that exist are based on expert opinion. Value exists in sharing a practical approach to caring for patients during the dying process, including topics to be addressed with family members, rationales for recommended care, and strategies for implementing comfort measures only. Through dedicated preparation and planning, clinicians can help family members navigate this intense experience.

SUMMARY

After a decision had been made to discontinue life-sustaining therapies, family members need to be given a clear description of comfort measures only and provided with additional detail about what it entails, including therapies or interventions to be discontinued, monitoring during the dying process, and common features of the dying process. Order sets can be a valuable resource for ensuring that adequate analgesia and sedation are available and the care plan is enacted properly. To achieve a good death for patients, a collaborative effort among members of the care team is essential.

Palliative Care in the Intensive Care Unit: The Standard of Care

Intensive care unit-based palliative care has evolved over the past 30 years due to the efforts of clinicians, researchers, and advocates for patient-centered care. Although all critically ill patients inherently have palliative care needs, the path was not linear but rather filled with the challenges of blending the intensive care unit goals of aggressive treatment and cure with the palliative care goals of symptom management and quality of life. Today, palliative care is considered an essential component of high-quality critical care and a core competency of all critical care nurses, advanced practice nurses, and other intensive care unit clinicians. This article provides an overview of the current state of intensive care unit-based palliative care, examines how the barriers to such care have shifted, reviews primary and specialist palliative care, addresses the impact of COVID-19, and presents resources to help nurses and intensive care unit teams achieve optimal outcomes.

The Experiences of Family Members of Patients Discharged from Intensive Care Unit: A Systematic Review of Qualitative Studies

BACKGROUND

Improving the understanding of the post-discharge experiences of family members after their loved ones leave the Intensive Care Unit (ICU) is essential for developing effective follow-up strategies. These strategies are crucial for mitigating potential negative outcomes for both patients and their families. The aim of this study was to explore the lived experiences of family members after the discharge of their loved ones from the ICU.

METHODS

In September 2023, we conducted a systematic search of qualitative studies across the following databases: CINAHL, MEDLINE, Scopus and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to guide this review.

RESULTS

Eight articles met the inclusion criteria. Four themes were identified following evidence synthesis: (1) grappling with a weighty burden; (2) recognizing and confronting adversities along the way; (3) seeking support beyond one's own resources; and (4) addressing comprehensive care requirements.

CONCLUSIONS

Family members face significant psychological and physical challenges while caring for their loved ones recovering from an ICU stay. Adequate formal and informal help is imperative to provide support both during hospitalization and after discharge. A refined understanding of the distinct requirements and experiences of family members can serve as a strategic framework for informing educational interventions and follow-up programs during the transition from hospital settings to community-based care. This study was not registered.

Research areas and trends in family-centered care in the 21st century: a bibliometric review

Introduction

Family-centered care (FCC) is a model of care provision that sees a patient's loved ones as essential partners to the health care team and positively influences the psychological safety of patients and loved ones.

Objectives

This review aims to present an overview of impactful publications, authors, institutions, journals, countries, fields of application and trends of FCC in the 21st century as well as suggestions on further research.

Methods

The Web of Science Database was searched for publications on FCC between January 2000 and Dezember 2023. After screening for duplicates, VOS Viewer and CiteSpace were used to analyze and visualize the data.

Results

Scientific interest in FCC has grown and resulted in the scientific output of 4,836 publications originating from 103 different countries. Based on the frequent author keywords, FCC was of greatest interest in neonatology and pediatrics, nursing, critical and intensive care, end-of-life and palliative care, and patient-related outcomes. The recent research hotspots are "patient engagement," "qualitative study," and "health literacy."

Conclusion

FCC has gained recognition and spread from the pediatric to the adult palliative, intensive, end-of-life and geriatric care settings. This is a very reassuring development since adults, especially when older, want and need the assistance of their social support systems. Recent research directions include the involvement of patients in the development of FCC strategies, health literacy interventions and the uptake of telemedicine solutions.

Development and validation of a supportive programme for family caregivers of children suffering from cystic fibrosis: protocol for a sequential exploratory mixed-methods study

INTRODUCTION

Families with children who have cystic fibrosis (CF) face a multitude of challenges. They require complex and time-consuming daily care, various forms of knowledge and intricate care responsibilities. One of the most critical challenges that Iranian families of children with CF face is the lack of adequate support from health teams in the early stages of diagnosis, frequent hospitalisation and the postdischarge process. Unfortunately, limited studies have been conducted in this field, and the Iranian society lacks a comprehensive support programme for these families after leaving treatment centres or home care teams. Therefore, it is necessary to identify and redefine the needs of these families for better care and support in Iran.

METHODS AND ANALYSIS

A mixed-method research design with an exploratory sequential approach will be used in this study. The study consists of three stages: stage (1) the qualitative phase (conventional content analysis and scoping review); stage (2) the programme design phase (development of a support programme) and stage (3) the quantitative phase (validation of the programme through the Delphi method). In the first stage, data will be collected through interviews. Key concepts, evidence and gaps in research will also be identified, collected and analysed through a scoping review. In the second stage, a support programme will be designed based on the results of the content analysis of interviews and the findings from the scoping review. In the final phase, the study will aim to validate the designed programme through a Delphi study.

ETHICS AND DISSEMINATION

This study formed part of a Ph.D. degree and was approved by the ethics committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.395). Informed consent will be obtained from all study participants. Findings will be published in a peer-reviewed journal.

Applying Lessons From Ars Moriendi to Foster Dying Well in Acute Care Settings

Medical and technological advances have made it possible to keep people alive well beyond what was once possible, leading health care providers to focus on life-sustaining measures rather than questioning the futility of such measures and considering quality of life. In the midst of the struggle to foster dying well in a medicalized environment, acute care nurses may be challenged with shifting the focus to providing optimal end-of-life care because of lack of training, time, and resources. A remedy for the current western societal approach to medicalized dying is to look back in history to a time during the late Middle Ages, when death was an accepted part of medieval life. A literary genre called Ars Moriendi (translated "the art of dying") was written and illustrated to provide instruction on how to die well and how to care for the dying. Nurses can apply lessons from this text to fulfill the ethical obligation to practice with dignity and provide compassionate end-of-life care. These lessons include helping patients and families identify goals of care and accept finitude, encouraging the participation of loved ones at the bedside, and fostering reconciliation at the end of life.

Reliability and validity of the training satisfaction questionnaire for family members (TSQ-FM) entering the ICU during an isolation disease outbreak

BACKGROUND

The presence of family members in an isolated ICU during an isolation disease outbreak is restricted by hospital policies because of the infectious risk. This can be overcome by conferring to family members the skill and the ability to safely don and doff the personal protective equipment (PPE) through a nurse-led training intervention and assess their satisfaction, to respond to the need to define a safe, effective and quality care pathway focused on Family-Centered Care (FCC) principles.

OBJECTIVE

the study aimed to build a valid and reliable instrument for clinical practice to assess family members' satisfaction to allow ICU nurses to restore family integrity in any case of infectious disease outbreak that requires isolation.

METHODS

A cross-sectional study was conducted to test the psychometric properties. The questionnaire was constructed based on a literature review on the needs of family members in the ICU. 76 family members were admitted to a COVID-ICU. Cronbach's coefficient, Geomin rotated loading, and EFA were applied to assess the reliability and validity of the instrument.

RESULTS

The Kaiser-Mayer-Olkin (KMO) measure was 0.662, the Bartlett sphericity test showed a significant p-value (χ²=448.33; df=45; p < 0.01), Cronbach's alpha coefficient was.896. A further CFA analysis confirmed that all fit indices were acceptable. The results showed satisfactory validity and reliability, which could be generalized and extended to any outbreak of isolation disease.

CONCLUSIONS

This study provides a valid and reliable instrument for clinical practice to maintain family integrity in the dyadic relationship between the patient and the family member, even during an emergency infectious disease outbreak that requires isolation.

Process of Withdrawal of Mechanical Ventilation at End of Life in the ICU: Clinician Perceptions

BACKGROUND

Nearly one-quarter of all Americans die in the ICU. Many of their deaths are anticipated and occur following the withdrawal of mechanical ventilation (WMV). However, there are few data on which to base best practices for interdisciplinary ICU teams to conduct WMV.

RESEARCH QUESTION

What are the perceptions of current WMV practices among ICU clinicians, and what are their opinions of processes that might improve the practice of WMV at end of life in the ICU?

STUDY DESIGN AND METHODS

This prospective two-center observational study conducted in Boston, Massachusetts, the Observational Study of the Withdrawal of Mechanical Ventilation (OBSERVE-WMV) was designed to better understand the perspectives of clinicians and experience of patients undergoing WMV. This report focuses on analyses of qualitative data obtained from in-person surveys administered to the ICU clinicians (nurses, respiratory therapists, and physicians) caring for these patients. Surveys assessed a broad range of clinician perspectives on planning, as well as the key processes required for WMV. This analysis used independent open, inductive coding of responses to open-ended questions. Initial codes were reconciled iteratively and then organized and interpreted using a thematic analysis approach. Opinions were assessed on how WMV could be improved for individual patients and the ICU as a whole.

RESULTS

Among 456 eligible clinicians, 312 in-person surveys were completed by clinicians caring for 152 patients who underwent WMV. Qualitative analyses identified two main themes characterizing high-quality WMV processes: (1) good communication (eg, mutual understanding of family preferences) between the ICU team and family; and (2) medical management (eg, planning, availability of ICU team) that minimizes patient distress. Team member support was identified as an essential process component in both themes.

INTERPRETATION

Clinician perceptions of the appropriateness or success of WMV prioritize the quality of team and family communication and patient symptom management. Both are modifiable targets of interventions aimed at optimizing overall WMV.

Associations Between Family-Assessed Quality-of-Dying-and-Death Latent Classes and Bereavement Outcomes for Family Surrogates of ICU Decedents

OBJECTIVES

To examine associations between family surrogates' bereavement outcomes and four previously determined quality of dying and death (QODD) latent classes (high, moderate, poor-to-uncertain, and worst).

DESIGN

Prospective, longitudinal, observational study.

SETTING

Medical ICUs at two academically affiliated medical centers in Taiwan.

PATIENTS/PARTICIPANTS

Three hundred nine family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Health Evaluation II scores > 20) from a disease.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Participants were assessed by the depression and anxiety subscales of the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, 11 items of the Prolonged Grief Disorder (PGD) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey at 1, 3, 6, 13, 18, and 24 months post-loss. We simultaneously examined associations of four QODD latent classes with physical and mental health-related quality of life (HRQOL) and symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and PGD assessed over 24 bereavement months using multivariate hierarchical linear modeling. Surrogates' distinct QODD latent classes assessed at 1-month post-loss were significantly associated with bereavement outcomes, except for physical HRQOL and PGD symptoms. Significantly more depressive symptoms and worse mental HRQOL (β [95% CI]) were reported by bereaved surrogates in the moderate (1.958 [1.144-2.772], -2.245 [-3.961 to -0.529]), poor-to-uncertain (2.224 [1.438-3.010], -7.026 [-8.683 to -5.369]), and worst (2.081 [1.215-2.964], -4.268 [-6.096 to -2.440]) QODD classes than those in the high QODD class. Bereaved surrogates in the moderate (2.095 [1.392-2.798]) and poor-to-uncertain (0.801 [0.123-1.480]) QODD classes reported more anxiety symptoms, whereas those in the poor-to-uncertain QODD class suffered more PTSD symptoms (2.889 [1.005-4.774]) than those in the high QODD class.

CONCLUSIONS

The four distinct QODD latent classes were significantly associated with ICU family surrogates' bereavement outcomes, suggesting targets to improve end-of-life care quality in ICUs.

Opening Pandora's box by generating ICU diaries through artificial intelligence: A hypothetical study protocol

BACKGROUND

Patients and families on Intensive Care Units (ICU) benefit from ICU diaries, enhancing their coping and understanding of their experiences. Staff shortages and a limited amount of time severely restrict the application of ICU diaries. To counteract this limitation, generating diary entries from medical and nursing records using an artificial intelligence (AI) might be a solution.

DESIGN AND PURPOSE

Protocol for a hypothetical multi-center, mixed method study to identify the usability and impact of AI-generated ICU diaries, compared with hand-written diaries.

METHOD

A hand-written ICU diary will be written for patients with expected length of stay ≥ 72 h by trained nursing staff and families. Additionally at discharge, the medical and nursing records are analyzed by an AI software, transformed into understandable, empathic diary entries, and printed as diary. Based on an appointment with patients within 3 months, diaries are read in randomized order by trained clinicians with the patients and families. Patients and families will be interviewed about their experiences of reading both diaries. In addition, usability of diaries will be evaluated by a questionnaire.

EXPECTED FINDINGS AND RESULTS

Patients and families describe the similarities and differences of language and the content of the different diaries. In addition, concerns can be expressed about the generation and data processing by AI.

IMPLICATIONS FOR PRACTICE

Professional nursing involves empathic communication, patient-centered care, and evidence-based interventions. Diaries, beneficial for ICU patients and families, could potentially be generated by Artificial Intelligence, raising ethical and professional considerations about AI's role in complementing or substituting nurses in diary writing.

CONCLUSIONS

Generating AI-based entries for ICU diaries is feasible, but raises serious questions about nursing ethics, empathy, data protection, and values of professional nurses. Researchers and developers shall discuss these questions in detail, before starting such projects and opening Pandora's box, that can never be closed afterwards.

Post-Intensive Care Syndrome in Neurocritical Care Patients

Post-intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.

Parents' Experiences Caring for a Child after a Critical Illness: A Qualitative Study

Objectives  This article described parents' experience and identifies outcomes important to parents following their child's critical illness. Methods  Semistructured interviews with 22 female and 4 male parents representing 26 critically ill children with predominately neurologic and respiratory diagnoses. Most children were younger than 5 years at discharge with a median (interquartile range) of 2 (2.0-3.0) years from discharge to interview. Results  Many children returned home with life-altering physical and cognitive disabilities requiring months to years of rehabilitation. Parents remembered feeling unprepared and facing an intense, chaotic time when the child first returned home. They described how they suddenly had to center their daily activities around the child's needs amidst competing needs of siblings and partners, and in some cases, the medicalization of the home. They recounted negotiating adjustments almost daily with insurance agencies, medical doctors and therapists, employers, the child, and other family members to keep the family functioning. In the long term, families developed a new norm, choosing to focus on what the child could still do rather than what they could not. Even if the child returned to baseline, parents remembered the adjustments made to keep the child alive and the family functioning. Conclusion  Heightened awareness of family experiences after pediatric critical illness will allow health care providers to improve family preparedness for the transition from hospital to home.

Family centeredness of care: a cross-sectional study in intensive care units part of the European society of intensive care medicine

PURPOSE

To identify key components and variations in family-centered care practices.

METHODS

A cross-sectional study, conducted across ESICM members. Participating ICUs completed a questionnaire covering general ICU characteristics, visitation policies, team-family interactions, and end-of-life decision-making. The primary outcome, self-rated family-centeredness, was assessed using a visual analog scale. Additionally, respondents completed the Maslach Burnout Inventory and the Ethical Decision Making Climate Questionnaire to capture burnout dimensions and assess the ethical decision-making climate.

RESULTS

The response rate was 53% (respondents from 359/683 invited ICUs who actually open the email); participating healthcare professionals (HCPs) were from Europe (62%), Asia (9%), South America (6%), North America (5%), Middle East (4%), and Australia/New Zealand (4%). The importance of family-centeredness was ranked high, median 7 (IQR 6-8) of 10 on VAS. Significant differences were observed across quartiles of family centeredness, including in visitation policies availability of a waiting rooms, family rooms, family information leaflet, visiting hours, night visits, sleep in the ICU, and in team-family interactions, including daily information, routine day-3 conference, and willingness to empower nurses and relatives. Higher family centeredness correlated with family involvement in rounds, participation in patient care and end-of-life practices. Burnout symptoms (41% of respondents) were negatively associated with family-centeredness. Ethical climate and willingness to empower nurses were independent predictors of family centeredness.

CONCLUSIONS

This study emphasizes the need to prioritize healthcare providers' mental health for enhanced family-centered care. Further research is warranted to assess the impact of improving the ethical climate on family-centeredness.

Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association

Patient-centered care is gaining widespread acceptance by the medical and lay communities and is increasingly recognized as a goal of high-quality health care delivery. Patient-centered care is based on ethical principles and aims at establishing a partnership between the health care team and patient, family member, or both in the care planning and decision-making process. Patient-centered care involves providing respectful care by tailoring management decisions to patients' beliefs, preferences, and values. A collaborative care approach can enhance patient engagement, foster shared decision-making that aligns with patient values and goals, promote more personalized and effective cardiovascular care, and potentially improve patient outcomes. The objective of this scientific statement is to inform health care professionals and stakeholders about the role and impact of patient-centered care in adult cardiovascular medicine. This scientific statement describes the background and rationale for patient-centered care in cardiovascular medicine, provides insight into patient-oriented medication management and patient-reported outcome measures, highlights opportunities and strategies to overcome challenges in patient-centered care, and outlines knowledge gaps and future directions.

Quality of Life, Family Support, Spirometry, and 6-Minute Walking Distance Differences between COVID-19 and Non-COVID-19 Intensive Care Unit Patients in One Year Following Hospital Discharge

BACKGROUND

Critically ill patients after Intensive Care Unit (ICU) discharge may present disability in their cognitive and physical functions.

OBJECTIVES

To investigate the quality of life (QoL) of both COVID-19 and non-COVID-19 patients following ICU discharge, lung function, and physical performance of participants.

METHODS

This study was prospective and conducted between 2020 and 2021 in the "X" hospital. If patients were Mechanically-Ventilated (MV) > 48 h, they were included.

RESULTS

Fifty COVID-19 and seventy-two non-COVID-19 participants were included in this study. The mean (SD) of the total SF-36 scores at COVID-19 patients at hospital discharge and 3 and 12 months were 46.5 (14.5), 68.6 (17.8), and 82.3 (8.9) (p < 0.05), while non-COVID-19 participants were 48.5 (12.1), 72.2 (9.9), and 82.7 (5.4) (p < 0.05). The forced expiratory volume in one second (FEV1) and 6-minute walking distance (6MWD) were assessed at 3 and 12 months and significantly improved over 12 months.

CONCLUSION

The QoL of COVID-19 patients improved significantly over time as FEV1 and 6MWD.

Translation and Psychometric Validation of the German Version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ): A Cross-Sectional Study

Supporting families experiencing critical illness through family interventions is essential to ease illness burden, enable family management, and reduce their risk for adverse health. Thus far, there is no validated German instrument to measure the perceived support families receive from nurses. We translated the 14-item Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and tested its psychometric properties with 77 family members of intensive care patients. Compared with the original instrument, the construct validity of the German ICE-FPSQ (FPSQ-G) showed unstable results with a partially divergent structure, most likely caused by the limited sample size. The first two principal components explained 61% of the overall variance and a good internal consistency with a Cronbach's alpha of .92. The FPSQ-G is a promising instrument to measure family members' perceptions of the support they received from nurses in the acute critical care setting but requires further validation.

A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals

Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.

A randomised controlled trial of a nurse facilitator to promote communication for family members of critically ill patients

PURPOSE

Suboptimal communication with clinicians, fragmented care and failure to align with patients' preferences are determinants of post intensive care unit (ICU) burden in family members. Our aim was to evaluate the impact of a nurse facilitator on family psychological burden.

METHODS

We carried out a randomised controlled trial in five ICUs in France comparing standard communication by ICU clinicians to additional communication and support by nurse facilitators. We included patients > 18 years, with expected ICU length of stay > 2 days, chronic life-limiting illness, and their family members. Facilitators were trained to help families to secure care in line with patient's goals, beginning in ICU and continuing for 3 months. Assessments were made at baseline and 1, 3 and 6 months post-randomisation. Primary outcome was the evolution of family symptoms of depression over 6 months using a linear mixed effects model on the depression subscale of the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included HADS-Anxiety, Impact of Event Scale-6, goal-concordant care and experience of serious illness (QUAL-E).

RESULTS

385 patients and family members were enrolled. Follow-up at 1-, 3- and 6-month was completed by 284 (74%), 264 (68.6%) and 260 (67.5%) family members respectively. The intervention was associated with significantly more formal meetings between the ICU team and the family (1 [1-3] vs 2 [1-4]; p < 0.001). There was no significant difference between the intervention and control groups in evolution of symptoms of depression over 6 months (p = 0.91), nor in symptoms of depression at 6 months [0.53 95% CI (- 0.48; 1.55)]. There were no significant differences in secondary outcomes.

CONCLUSION

This study does not support the use of facilitators for family members of ICU patients.

Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis

OBJECTIVE

This study is conducted as a bibliometric analysis to determine the trends in studies related to family-centered care in children.

MATERIALS AND METHODS

The Web of Science database was used to collect study data. A search was conducted on Web of Science using the keywords "family-centered care", "family centered care", "family-centred care", "family centred care", "family-integrated care", "family integrated care", "patient and family centered care", "patient- and family-centered care" and "child" or "pediatric" or "pediatrics" or "child" or "newborn" or "neonatal" or "adolescent" together. The VOSviewer program was used for data analysis and visualization. The analysis included the number of publications by year, distribution by journals, most cited studies, countries with the highest publication output, most frequently used keywords, and co-authorship dimensions, presented with visual maps.

RESULTS

A total of 2525 studies conducted from 1980 onwards were analyzed. The analysis revealed that the initial publications related to the subject emerged in 1980, and the United States was identified as the country with the highest number of publications, based on the Web of Science database. The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) was determined as the journal with the highest number of publications, while the journal receiving the most citations was PEDIATRICS.

CONCLUSION

The study found an increasing importance given to the Family-Centered Care Approach since the 1980s, with a majority of studies being descriptive in nature. It was determined that the studies were concentrated in the USA indicating a lack of global interest in the Family-Centered.

PRACTICAL IMPLICATIONS

Nursing researchers can build upon this study in the field of family-centered care by conducting more specific and in-depth investigations. This contributes to adding new information to the nursing literature and filling gaps in this area.

Disparity drivers, potential solutions, and the role of a health equity dashboard in the neonatal intensive care unit: a qualitative study

OBJECTIVE

Racial/ethnic disparities are well-described in the neonatal intensive care unit (NICU). We explored expert opinion on their etiology, potential solutions, and the ability of health equity dashboards to meaningfully capture NICU disparities.

STUDY DESIGN

We conducted 12 qualitative semi-structured interviews, purposively selecting a diverse group of neonatal experts. We used grounded theory to develop codes, shape interviews, and conduct analysis.

RESULT

We identified three sources of disparity: interpersonal bias, care process and institutional barriers, and social determinants of health, particularly as they affect parental engagement in the NICU. Proposed solutions included racial/cultural concordance, bolstering hospital-based resources, and policy interventions. Health equity dashboards were viewed as useful but limited, because clinical metrics do not account for many of the aforementioned sources of disparities.

CONCLUSION

Equity dashboards serve as a motivational starting point for quality improvement; future iterations may require novel, qualitative data sources to identify underlying etiologies of NICU disparities.

Family Members' Engagement in Symptom Communication, Assessment, and Management in the Intensive Care Unit: A Qualitative Study

BACKGROUND

Opportunities for communication and participation in decision making are limited for critically ill patients, but family members serving as surrogates enable empowerment of these patients.

OBJECTIVE

The aim of this study was to explore family members' engagement in symptom communication in the intensive care unit.

METHODS

A qualitative descriptive design using fieldwork methodology with triangulation of participant observation and individual interviews was conducted. Nine mechanically ventilated patients were observed in interaction with family members and clinicians in the intensive care unit. Six of the observed patients, 6 family members, and 9 clinicians were interviewed after participant observation. Field notes and transcripts were analyzed using Braun and Clarke's method of thematic analysis.

RESULTS

Family members engaged actively in symptom communication, assessment, and management, and there were barriers and facilitators to family engagement. Three main themes and 9 subthemes describing family engagement emerged: (1) intermediary role (recognize and report symptoms, provide patient information, and assist in communication), (2) independent role (provide familiarity, manage symptoms, and promote patient communication), and (3) conditions for family engagement (intensive care unit environment, relationship with the patient, and patient preferences).

DISCUSSION

Family members have unique knowledge of the patient that differs from and complement the competence of the staff, and might contribute to improved symptom communication. Future research should examine how family members can contribute to symptom communication, assessment, and management.

Parental supporter in pediatric resuscitation: A mixed-method study with Delphi and analytic hierarchy process

INTRODUCTION

Providing support to parents is an evidence-based practice and a crucial part of family-centered nursing care. However, it is not clear who and how to provide the best support to parents during and after their child's resuscitation attempts.

PURPOSE

This study was conducted to explore the characteristics and roles of parental supporters responsible for caring for parents during and after their child's resuscitation.

METHODS

This is a mixed-method study combining the Delphi technique and the Analytic Hierarchy Process. A list of potentially important items describing the characteristics and roles of parental supporters caring for parents during and after pediatric resuscitation was developed through qualitative interviews with parents and members of the resuscitation team, and a thorough literature search. Then, the Delphi round was conducted with key experts. In the final step, the Analytic Hierarchy Process was used for ranking items in the order of their importance.

RESULTS

A list with 69 items describing the characteristics and roles of parental supporters was developed. 15 items (21.74%) were related to the "Characteristics of parental supporter" category; 8 items (11.59%) were related to the "Roles of a parental supporter during resuscitation" category; 13 items (18.84%) were related to the "Roles of a parental supporter after successful resuscitation" category; 23 items (33.34%) were related to the "Roles of a parental supporter after unsuccessful resuscitation" category; and 10 items (14.49%) were related to the "Roles of a parental supporter after unsuccessful resuscitation with help of other staff of the hospital" category.

CONCLUSION

The findings of this study can be used to develop guidelines that include parental supporter characteristics and roles to support parents during and after their child's resuscitation according to family-centered care practices in pediatric settings.

CLINICAL RELEVANCE

Study findings indicate the need for the presence of a parental supporter during and after pediatric resuscitation, whether witnessed by the parents or not. Knowledge regarding the characteristics and roles of parental supporters can be used in practice to uphold family-centered nursing care during critical situations.