Family members' satisfaction with care and decision-making in intensive care units and post-stay follow-up needs-a cross-sectional survey study

Effects of participation in interdisciplinary rounds in the intensive care unit on family satisfaction: A cross-sectional study

OBJECTIVE

To investigate whether family participation in intensive care unit interdisciplinary bedside rounds affects family satisfaction.

METHODS

A cross-sectional study was conducted at a 56-bed, adult, mixed intensive care unit of a tertiary hospital in Southern Brazil. From May to June 2019, family members of patients who stayed in the intensive care unit for at least 48 hours were invited to participate in the study at the time of patient discharge. The main exposure variable was participation in intensive care unit bedside rounds during the intensive care unit stay. Family satisfaction was assessed by using the Brazilian version of the Family Satisfaction in the Intensive Care Unit questionnaire.

RESULTS

Of the 234 screened individuals, 118 were included. Eleven participants withdrew consent. A total of 107 individuals were assessed; 58 (54%) reported being present during bedside rounds, and 49 (46%) reported never being present. General satisfaction and satisfaction with the decision-making process were higher among families who were present during rounds than among families who were not (p = 0.01 and p = 0.007, respectively).

CONCLUSION

The presence during interdisciplinary rounds was associated with improved general satisfaction and satisfaction with the decision-making aspect. This outcome indicates that efforts must be directed to conduct studies with more robust methodologies to confirm this association.

Satisfaction of patients and family caregivers in adult intensive care units: Literature Review

Intensive care units are hostile places, which must be conditioned to the needs of patients and families, and therefore the factors that influence their satisfaction must be known.

OBJECTIVE

To update the knowledge on the satisfaction of the patients admitted to an adult intensive care unit and that of their family caregivers as described in the scientific literature.

METHODOLOGY

A systematized literature review was carried out in PubMed, Scopus, Cinahl and WOS databases.

SEARCH STRATEGY

"Personal Satisfaction" and (patients or caregivers) and "Intensive Care Units".

INCLUSION CRITERIA

studies published between 2013-2018, population aged between 19-64 years, English and Spanish language.

RESULTS

760 studies were located and 15 were selected. The factors that increased satisfaction are: good communication with professionals (n = 5), the quality of care (n = 4), and the cleanliness and environment of the units (n = 2). The factors that produced dissatisfaction are: the infrastructure of the waiting room (n = 5), inadequate communication (n = 4), and the involvement of families and patients in decision-making (n = 4). Training of professionals (n = 5), inclusion of the family during the process of hospitalization (n = 2) and redesigning the waiting room (n = 2) are some of the suggestions for improvement.

CONCLUSIONS

Factors related to professionals, environment and cleanliness of the units are satisfaction-generating factors. Factors generating dissatisfaction related to poor infrastructure, a lack of involvement in decision-making and poor professional communication. Strategies to improve patient and family satisfaction relate to the organization, professionals, family members, and infrastructure and environment.

Anxiety, social support and satisfaction of patients' families in intensive care units: A descriptive-correlational study

AIMS & OBJECTIVES

This study was conducted with family members of patients' in the intensive care unit (ICU) to identify their anxiety level, social support and satisfaction with the ICU.

BACKGROUND

Admission of critical patients to the ICU usually involves the participation of family members.

DESIGN

A descriptive-correlational design was used and reported according to the STROBE checklist.

METHODS

The sample consisted of 250 family members in ICUs in a city of Turkey. Data were collected by the Multidimensional Perceived Social Support Scale, the State-Trait Anxiety Inventory and the Family Satisfaction in the Intensive Care Unit scale.

RESULTS

A negative correlation was found between family satisfaction of the ICU and state anxiety (r = -0.349, p < 0.001), and a negative relationship between the satisfaction of the ICU and trait anxiety of the participants (r = -0.151, p < 0.05). There was a significant relationship between the state anxiety level (Adjusted R² = 0.080, F = 8.247, p < 0.001), trait anxiety level (Adjusted R² = 0.185, F = 19.821, p < 0.001), the perceived social support (Adjusted R² = 0.094, F = 9.640, p < 0.001) and satisfaction (Adjusted R² = 0.013, F = 4.161, p < 0.001) of family members and their sociodemographic characteristics.

CONCLUSIONS

The study concluded that anxiety levels of relatives of the families were high, their social support and satisfaction with the intensive care unit were at a moderate level. There was a correlation between anxiety levels, satisfaction with the intensive care unit, and the perceived social support of families.

RELEVANCE TO CLINICAL PRACTICE

Holistic care for the psychosocial needs of families who have a member in the ICU should be planned to increase satisfaction. Nurses should observe families closely for anxiety, allow them to ask questions and include them in the care of their family member.

A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit

BACKGROUND

Partnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically.

OBJECTIVE

The objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU).

METHODS

A retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from "poor" (0) to "excellent" (100).

RESULTS

In total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients' treatment in the ICU and appreciation for the care, skill, and professionalism of the staff.

CONCLUSION

Very high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.

The expressed support needs of families of adults who have survived critical illness: A thematic synthesis

BACKGROUND

Surviving critical illness can result in ongoing psychological, physical and cognitive impairments for both survivors and families. During the time from the critical illness through to the period of adaptation back to community living, families, alongside survivors, have support needs.

OBJECTIVES

This systematic review aimed to provide an in-depth insight into the expressed support needs of families of adults who survived an admission to an intensive care unit and returned to a home environment. It also aimed to explore how these needs change over time, and what support provisions families perceived to be helpful.

METHODS

This was a systematic review using thematic synthesis methodology. Predefined searches were conducted in CINAHL, Medline, PsychINFO, SocIndex, EMbase, Academic Search Complete, EThOS and OpenGrey to locate studies published in English from 2000. Two reviewers screened each study against the inclusion criteria. Quality appraisal was undertaken using Joanna Briggs Institute tools. Extracted data were managed in Nvivo12® and analysed to identify descriptive and analytical themes. The Timing it Right Framework was used to frame changes in need across the recovery continuum.

RESULTS

Thirty-nine studies were included, 30 qualitative, eight quantitative and one mixed methods. Five key family needs were identified across the recovery continuum: for security; to make sense of the situation; finding a balance; holding everything together; and for trust.

DISCUSSION

Families found the following interventions helpful: written information; care coordination and navigation; input from intensive care staff after discharge to support continuity; and provision of family support groups. Although there are similarities between the needs of families and survivors, there are sufficient differences to warrant the development of processes to identify and address family need throughout the recovery continuum.

CONCLUSION

More research is required to develop a tool to better identify the needs of families across the recovery continuum, identify gaps in current service provision, and design interventions to meet these needs.

STUDY REGISTRATION

CRD42019136883 (PROSPERO).

The Association Between Quality and Safety Climate of a Hospital Ward, Family Members' Empowerment, and Satisfaction With Provided Care

PURPOSE

This study was designed to examine the perceptions of ward quality and safety held by family members and nurses, and investigate its impact on family members' empowerment, and satisfaction with patient hospitalization.

DESIGN

A cross-sectional study on two study groups was conducted at a large public hospital in Israel. The first group comprised 86 family members of patients hospitalized for more than 72 hours in acute critical condition in intensive care units (ICU) or general wards (GW). The second group included 101 registered nurses who treated the patients in the ICU or GW.

METHODS

Data were collected by a validated self-administered structured questionnaire. All participants voluntarily signed an informed consent and answered questions related to their demographic characteristics, perceptions, and attitudes toward quality and safety climate, empowerment, and satisfaction with the patients' hospitalization. Pearson correlations coefficient, t-test for independent samples, and a multiple regression model were performed to analyze the data.

FINDINGS

The mean age of family members was 51.4 ± 14.1 years and of nurses was 40.9 ± 9.9 years. A significant positive association was found between ward quality and safety climate and empowerment of the family member (r = .716; p < .001); empowerment of the family member and family members' satisfaction with the patients' hospitalization (r = .695; p < .001); and ward safety and quality climate and family members' satisfaction with the patients' hospitalization (r = .763; p <.001). Family members ranked ward quality and safety climate (M = 4.20 ± 0.60 vs. M = 3.61 ± 0.40), and their satisfaction with the patients' hospitalization (M = 4.49 ± 0.69 vs. M = 4.07± 0.54), which were significantly (p < .001) higher than the nurses' estimate. The significant predictors for family members' satisfaction with patients' hospitalization were commitment to quality leadership (b = .210; p = .027); implementing a quality improvement (b = .547; p < .001); and hand-off communication (b = .299; p = .001).

CONCLUSIONS

Positive relationships between quality and safety climate, empowerment, and satisfaction with patients' hospitalization suggest that by improving the ward quality and safety climate, and family empowerment, we may also improve family satisfaction. Although family members reported being satisfied with hospitalization in the ICU and GW, quality leadership and implementing a quality improvement among the nurses and hand-off communication between nurses and patients' families, will be targeted to improve family satisfaction with the patients' hospitalization.

CLINICAL RELEVANCE

Nurses who provide care for patients in a critical condition should maintain high levels of safety and quality care in order to improve the patients' family empowerment and satisfaction. Specifically, their efforts should target a commitment to quality leadership, implementing quality improvement, and hand-off communication.

Predictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making

BACKGROUND

There is a critical need to improve support for families making difficult shared decisions about patient care with clinicians in the neuroscience ICU (neuro-ICU). The aim of this study is to identify patient- and family-related factors associated with dissatisfaction with shared decision-making support among families of neuro-critically ill patients.

METHODS

We conducted a retrospective observational cohort study using survey data that had been collected from a consecutive sample of family members of patients in the neuro-ICU (one family member per patient) at two US academic centers. Satisfaction with shared decision-making support on ICU discharge had been measured among family members using one specific Likert scale item on the Family Satisfaction in the ICU 24 survey, a validated survey instrument for families of patients in the ICU. We dichotomized top-box responses for this particular item as an outcome variable and identified available patient- and family-related covariates associated with dissatisfaction (i.e., less than complete satisfaction) via univariate and multivariate analyses.

RESULTS

Among 355 surveys, 180 (49.5%) of the surveys indicated dissatisfaction with support during decision-making. In a multivariate model, no preexisting characteristics of families or patients ascertainable on ICU admission were predictive of dissatisfaction. However, among family factors determined during the ICU course, experiencing three or fewer formal family meetings (odds ratio 1.93 [confidence interval 1.13-3.31]; p = 0.01) was significantly predictive of dissatisfaction with decisional support in this cohort with an average patient length of stay of 8.6 days (SD 8.4). There was also a trend toward a family's decision to keep a patient as full code, without treatment limitations, being predictive of dissatisfaction (odds ratio 1.80 [confidence interval 0.93-3.51]; p = 0.08).

CONCLUSIONS

Family dissatisfaction with neuro-ICU shared decision-making support is not necessarily predicted by any preexisting family or patient variables but appears to correlate with participating in fewer formal family meetings during ICU admission. Future studies to improve family satisfaction with neurocritical care decision-making support should have broad inclusion criteria for participants and should consider promoting frequency of family meetings as a core strategy.

Family satisfaction in the intensive care unit, a cross-sectional study from Norway

BACKGROUND

Becoming critically ill represents not just a great upheaval for the patient in question, but also for the patient's closest family. In recent years, there has been a change in how the quality of the public health service is measured. There is currently a focus on how patients and their families perceive the quality of treatment and care. It can be challenging for patients to evaluate their stay in an intensive care unit (ICU) due to illness and treatment. Earlier studies show that the perceptions of the family and the patient may concur. It is important, therefore, to ascertain the family's level of satisfaction with the ICU stay. The aim of the study was to describe how the family evaluate their satisfaction with the ICU stay. A further aim was to identify which demographic variables were associated with differences in family satisfaction.

METHOD

The study had a cross-sectional design. A sample of 57 family members in two ICUs in Norway completed the questionnaire: Family satisfaction in the intensive care unit 24 (FS-ICU 24). Statistical analysis was conducted using the Mann-Whitney U test (U), Kruskal Wallis, Spearman rho and a performance-importance plot.

RESULTS

The results showed that families were very satisfied with a considerable portion of the ICU stay. Families were less satisfied with the information they received and the decision-making processes than with the nursing and care performed during the ICU stay. The results revealed that two demographic variables - relation to the patient and patient survival - significantly affected family satisfaction.

CONCLUSION

Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The results showed that some of the family demographic variables were significant for family satisfaction. The findings are clinically relevant since the results can strengthen intensive care nurses' knowledge when meeting the family of the intensive care patient.

Family ENgagement in Intensive Care Environments (FENICE): A quasi-experimental study protocol

Even if health care professionals should take into account the active involvement of families in Intensive Care Units (ICUs), little research that investigates family member’s contributions to care and includes its outcomes on both the family itself and the patient care, is available. The aim of this research project is to assess the effects of a family engagement program on family members’ satisfaction and on patients’ well-being and quality of life. A quasiexperimental study with two non-randomized groups (94 per each group) will be performed in two general ICUs of an Academic Italian Hospital. The intervention will be carried out in a single ICU and it consists of family members’ involvement in the care of their loved ones by means of bed physical exercises and simple care tasks. Participants will be evaluated through manifold outcomes: family satisfaction, assessed with the FS-ICU tool within 48 hours after ICU discharge; patients’ sense of well-being, measured with a visual analogue scale within 30 minutes after the time period of a visit; and the quality of life, investigated with the SF- 12 questionnaire within the first 48 hours after admission to ICU, at three and six months after ICU discharge by telephone. From July 2020, 188 subjects are going to be enrolled throughout the year. The latest data will be collected in December 2021 to allow the completion of the follow-ups of all participants. First, this study constitutes a significant step in a research agenda aimed at deepening the nursing sensitive outcomes in ICUs and the quality of hospital care. Secondly, the results of this study might have the potential to provide a better understanding of how families may modify patients’ outcomes and whether family members would benefit from an involvement program.

Satisfaction of patients and family caregivers in adult intensive care units: Literature Review

Intensive care units are hostile places, which must be conditioned to the needs of patients and families, and therefore the factors that influence their satisfaction must be known.

OBJECTIVE

To update the knowledge on the satisfaction of the patients admitted to an adult intensive care unit and that of their family caregivers as described in the scientific literature.

METHODOLOGY

A systematized literature review was carried out in PubMed, Scopus, Cinahl and WOS databases.

SEARCH STRATEGY

"Personal Satisfaction" and (patients or caregivers) and "Intensive Care Units".

INCLUSION CRITERIA

studies published between 2013-2018, population aged between 19-64 years, english and spanish language.

RESULTS

760 studies were located and 15 were selected. The factors that increased satisfaction are: good communication with professionals (n=5), the quality of care (n=4), and the cleanliness and environment of the units (n=2). The factors that produced dissatisfaction are: the infrastructure of the waiting room (n=5), inadequate communication (n=4), and the involvement of families and patients in decision-making (n=4). Training of professionals (n=5), inclusion of the family during the process of hospitalization (n=2) and redesigning the waiting room (n=2) are some of the suggestions for improvement.

CONCLUSIONS

Factors related to professionals, environment and cleanliness of the units are satisfaction-generating factors. Factors generating dissatisfaction related to poor infrastructure, a lack of involvement in decision-making and poor professional communication. Strategies to improve patient and family satisfaction relate to the organization, professionals, family members, and infrastructure and environment.

Development of family-based follow-up care system for patients with burn in Iran: Participatory action research

Aim

After the discharge of patients with burns, quality of life, psychological and social adjustment, performance and their follow-up are ambiguous. Therefore, we decided to improve the status of family-based care programmes in patients with the burn.

Design

Participatory action research.

Methods

The participatory action research was conducted between the Faculty of Nursing, Sina Hospital's managers and multidisciplinary burn teams from 2017-2018. The procedure for data collection included focus group meetings with key informants, interviews, observation, and questionnaire. Qualitative data were analysed using the qualitative content analysis and qualitative data were analysed by SPSSv.24.

Results

The study, comprised of four phases, started in May 2017 and completed in 9 months. The results of quantitative showed that quality of life has a statistically significant difference before and after the action. The qualitative data resulted were grouped into 3 categories and 28 subcategories and were analysed in the SWOT Matrix. All the multidisciplinary burn teams together with the managers as a team working of the care providers and the academic researcher resulted in enablers the changes in providing health education and services as well as improving the quality of life of patients and their families.

Validity and Reliability of a Thai Version of Family Satisfaction with Care in the Intensive Care Unit Survey

Purpose

To examine reliability and validity of a Thai version of the Family Satisfaction with Intensive Care Unit (FS-ICU 24) questionnaire and use this survey in intensive care units (ICUs) in Thailand.

Materials and methods

The standard English FS-ICU questionnaire was translated into the Thai language using translation and culture adaptation guidelines. After reliability and validity testing, we consecutively surveyed the satisfaction of family members of ICU patients over 1 year. Adult family members of patients admitted to medical or surgical ICUs for 48 hours or more who had visited the patients at least once during the ICU stay were included.

Results

In all, 315 (95%) of 332 surveys were returned from family members. Cronbach's α of the Thai FS-ICU 24 questionnaire was 0.95. Factor analysis demonstrated good construct validity. The mean (±SD) of total satisfaction score, overall ICU care subscale, and decision-making subscale were 81.5 ± 14.3, 81.0 ± 15.6, and 82.0 ± 14.0. Items with the lowest scores were the waiting room atmosphere and the frequency of doctors communicating with family members about the patient's condition. The mean total satisfaction score tended to be higher in family members of survivors than in family members of nonsurvivors (81.9 ± 13.8 vs 77.7 ± 16.2, p value = 0.059). The overall satisfaction scores between medial ICU and surgical ICU were not significantly different.

Conclusion

The Thai version of FS-ICU questionnaire was found to have acceptable reliability and validity in a Thai population and can be used to drive improvements in ICU care.

Trial registration

www.clinicaltrials.in.th, TCR20160603002

How to cite this article

Tajarernmuang P, Chittawatanarat K, Dodek P, Heyland DK, Chanayat P, Inchai J, et al. Validity and Reliability of a Thai Version of Family Satisfaction with Care in the Intensive Care Unit Survey. Indian J Crit Care Med 2020;24(10):946–954.

Clinicians’ moral distress and family satisfaction in the intensive care unit

This study explored the relationship between clinicians’ moral distress and family satisfaction with care in five intensive care units in Italy. A total of 122 clinicians (45 physicians and 77 nurses) and 59 family members completed the Italian Moral Distress Scale-Revised and the Family Satisfaction in the ICU questionnaire, respectively. Clinicians’ moral distress inversely correlated with family satisfaction related to the inclusion in the decision-making process. Specifically, physicians’ moral distress inversely correlated with satisfaction regarding the respect shown toward the patient. Nurses’ moral distress inversely correlated with satisfaction regarding breathlessness and agitation management, provision of emotional support, understanding of information, and inclusion in the decision-making process.

Family members' satisfaction with care and decision-making in intensive care units and post-stay follow-up needs-a cross-sectional survey study

Aim

The aim of this study was to explore family members' satisfaction with care and decision‐making during the intensive care units stay and their follow‐up needs after the patient's discharge or death.

Design

A cross‐sectional survey study was conducted.

Methods

Family members of patients recently treated in an ICU were participating. The questionnaire contented of background variables, the instrument Family Satisfaction in ICU (FS‐ICU 24) and questions about follow‐up needs. Descriptive and non‐parametric statistics and a multiple linear regression were used in the analysis.

Results

A total of 123 (47%) relatives returned the questionnaire. Satisfaction with care was higher scored than satisfaction with decision‐making. Follow‐ up needs after the ICU stay was reported by 19 (17%) of the participants. Gender and length of the ICU stay were shown as factors identified to predict follow‐up needs.