Unrecognized contributions of families in the intensive care unit

Family-centered interventions and patient outcomes in the adult intensive care unit: A systematic review of randomized controlled trials

OBJECTIVE

There is a need to understand how family engagement in the intensive care unit (ICU) impacts patient outcomes. We reviewed the literature for randomized family-centered interventions with patient-related outcomes in the adult ICU.

DATA SOURCES

The MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases were searched from inception until July 3, 2023.

STUDY SELECTION

Articles involving randomized controlled trials (RCTs) in the adult critical care setting evaluating family-centered interventions and reporting patient-related outcomes.

DATA EXTRACTION

Author, publication year, setting, number of participants, intervention category, intervention, and patient-related outcomes (patient-reported, physiological, clinical) were extracted.

DATA SYNTHESIS

There were 28 RCTs (12,174 participants) included. The most common intervention types were receiving care and meeting needs (N = 10) and family presence (N = 7). 16 RCTs (57%) reported ≥1 positive outcome from the intervention; no studies reported worse outcomes. Studies reported improvements in patient-reported outcomes such as anxiety, satisfaction, post-traumatic stress symptoms, depression, and health-related quality of life. RCTs reported improvements in physiological indices, adverse events, mechanical ventilation duration, analgesia use, ICU length of stay, delirium, and time to withdrawal of life-sustaining treatments.

CONCLUSIONS

Nearly two-thirds of RCTs evaluating family-centered interventions in the adult ICU reported positive patient-related outcomes.

KEYPOINTS

Question: Do family-centered interventions improve patient outcomes in the adult intensive care unit (ICU)?

FINDINGS

The systematic review found that nearly two-thirds of randomized clinical trials of family-centered interventions in the adult ICU improved patient outcomes. Studies found improvements in patient mental health, care satisfaction, physiological indices, and clinical outcomes. There were no studies reporting worse patient outcomes. Meaning: Many family-centered interventions can improve patient outcomes.

Psychometric Evaluation of the Family Willingness for Caregiving Scale

BACKGROUND

Family members and close friends of patients undergoing mechanical ventilation in the intensive care unit (ICU) often experience stress and a sense of helplessness. Participating in the care of their loved one may improve their adaptation to the ICU environment and better prepare them for caregiving after discharge.

OBJECTIVES

The primary aim of this study was to develop the Family Willingness for Caregiving Scale (FWCS) and test its psychometric properties. The secondary aim was to examine relationships between family members' demographic characteristics and caregiving willingness.

METHODS

The process of scale development followed DeVellis's 8-step method, and the scale was tested in 3 phases. The first 2 phases examined content validity and face validity, respectively. In phase 3, the FWCS was administered to a sample of family members currently visiting an ICU patient.

RESULTS

Content validity and face validity were confirmed. The internal consistency reliability of the scale was acceptable, and exploratory factor analysis revealed a 1-factor structure comprising both physical and emotional/supportive care tasks. Caregiving willingness differed significantly by sex, with women reporting greater willingness than men reported.

CONCLUSIONS

Further testing of the FWCS is needed. After refinement, the FWCS could be used to evaluate factors contributing to caregiving willingness of family members of ICU patients and advance the science related to family engagement in the ICU. Additionally, it could be used as a practical tool to suggest family caregiving activities in the ICU.

Association of COVID-19 Visitor Limitations and Goals of Care Discussions in the Intensive Care Unit

INTRODUCTION

The COVID-19 pandemic led to visitor restrictions in many hospitals. Since care in the surgical intensive care unit (SICU) often engages visitors as surrogate decision-makers, we investigated whether there was an association between COVID-19-related visitor restrictions, goals of care discussions (GOCD), and patient outcomes in SICU patients.

METHODS

We conducted a retrospective review of trauma and emergency general surgery (EGS) patients admitted to a rural tertiary SICU between July 2019 and April 2021, dividing patients into those admitted during COVID-19 visitor restrictions and those admitted at other times. Using univariate and multivariate logistic regression analyses, we compared the primary outcome, incidence of GOCD, and incidence of prolonged hospital (> 14 d) and intensive care unit length of stay (LOS, > 7 d) between the two groups.

RESULTS

One hundred seventy nine of 368 study patients (48.6%) presented during restricted visitation. The proportion of GOCD was 38.0% and 36.5% in the restricted and nonrestricted visitation cohorts, respectively (P = 0.769). GOCD timing and outcomes were similar in both groups. The use of telecommunication increased during restricted visitation, as did the proportion of trauma patients admitted to the SICU. On multivariable logistic regression, age and patient category were independent predictors of GOCD. On outcomes analysis, visitor restriction was associated with prolonged hospital LOS for EGS patients (odds ratio 2.44, 95% confidence interval 1.01-5.91, P value 0.048).

CONCLUSIONS

Restricted visitation was not associated with changes in frequency or outcome of GOCD, but was associated with prolonged hospital LOS among EGS patients who had SICU admissions. Further investigation of patient/surrogate satisfaction with virtual GOCD in the SICU setting is needed.

Capturing the Work of Patients' Family Members in the Medical Intensive Care Unit Using Naturalistic Observations

BACKGROUND

The contributions of cognitive and behavioral work of patients' family members in intensive care units remain largely unrecognized.

OBJECTIVE

The objective of this study was to develop a framework of outwardly observable family work, with specific focus on describing the physical space.

METHODS

We conducted approximately 50 hrs of naturalistic observations of family activities on a medical intensive care unit (MICU) at a large, Midwestern teaching hospital.

RESULTS

We created a framework of activities that include requesting, receiving, or delivering either information or action, along with examples. Further, we identified clinician and staff roles with whom families interact and characterized the physical spaces in which interactions take place.

CONCLUSIONS

Knowledge contribution is a proposed framework of family activities in the MICU. It has the potential to guide and be further described by future research and to inform development of human-centered family-facing interventions to support cognitive and behavioral cognitive and behavioral work.

Exploring patients' and relatives' needs and perceptions regarding family participation in essential care in the intensive care unit: A qualitative study

OBJECTIVES

To examine the needs, perceptions and influencing factors according to former adult intensive care unit patients and relatives with regard to family participation in essential care in the unit.

RESEARCH DESIGN

A qualitative interpretive descriptive study using inductive thematic analysis.

SETTING

Twelve pairs of former Dutch patients and their relatives were interviewed within two months after the patient's discharge from the unit between December 2017 and April 2018.

FINDINGS

Four themes emerged: the family's history, the patient's condition, supporting the patient and supporting the relative. The family's history, in particular the relationship with the patient and former experience with care, determined the level of participation in essential care. The level of participation was also influenced by the patient's condition, more specifically level of consciousness, stability of the patient's situation and length of the patient's stay. The third theme, supporting the patient, related to presence/being able to 'be there' for the patient and a mostly positive attitude towards family participation. The last theme was supporting the relative, with three subthemes associated with relatives' needs and perceptions: (dis)comfort with participation in essential care, need for invitation and support, and concern about the possible strain experienced by relatives.

CONCLUSION

Supporting the patient and supporting the relative are reflecting the needs and perceptions of patients and relatives regarding family participation in essential care. Both the family's history and the patient's condition influence the relative's level of participation. Intensive care unit nurses and other healthcare providers could take these themes into account when encouraging family participation in essential care.

IMPLICATIONS FOR CLINICAL PRACTICE

Patients' and relatives' needs and perceptions of family participation in essential care in the intensive care unit vary. Family participation in essential care is influenced by the family's history and the patient's condition. Healthcare providers could take these findings into account when implementing family participation in essential care.

Family participation in essential care activities in adult intensive care units: An integrative review of interventions and outcomes

AIMS AND OBJECTIVES

To systematically review interventions and outcomes regarding family participation in essential care in adult intensive care units.

BACKGROUND

Patients and relatives may benefit from family participation in essential care activities.

DESIGN

An integrative literature review.

METHODS

The following databases were systematically searched from inception to January 25, 2021: PubMed, CINAHL, EMBASE, MEDLINE, Cochrane, Web of Science and reference lists of included articles. Studies were included when reporting on family participation in essential care activities in intensive care including interventions and outcomes. Quality of the studies was assessed with the Kmet Standard Quality Assessment Criteria. Interventions were assessed, using the TIDieR framework. Data were extracted and synthesised narratively.

RESULTS

A total of 6698 records were screened, and 322 full-text studies were assessed. Seven studies were included, describing an intervention to support family participation. Four studies had a pretest-posttest design, two were pilot feasibility studies and one was observational. The quality of the studies was poor to good, with Kmet-scores: 0.50-0.86 (possible score: 0-1, 1 being the highest). Five studies offered various essential care activities. One study provided sufficient intervention detail. Outcome measures among relatives varied from mental health symptoms to satisfaction, supportiveness, comfort level and experience. Two studies measured patient outcomes: delirium and pressure ulcers. Among ICU healthcare providers, perception, comfort level and experience were assessed. Since outcome measures varied, only narrative synthesis was possible. Family participation is associated with a reduction of anxiety and PTSD symptoms.

CONCLUSION

Intervention descriptions of family participation in essential care activities are generally inadequate and do not allow comparison and replication. Participation of relatives was associated with a significant reduction in mental health symptoms. Other outcome measures varied, therefore, the use of additional outcome measures with validated measurement instruments should be considered.

RELEVANCE TO CLINICAL PRACTICE

The review contributed further insight into interventions aiming at family participation in essential care activities in the intensive care unit and their outcomes.

NO PATIENT OR PUBLIC CONTRIBUTION

Neither patients nor public were involved.

Unidentified communication challenges in the intensive care unit: A qualitative study using multiple triangulations

BACKGROUND

Communication in the intensive care unit is challenged by patients' inability to speak owing to intubation, treatment, and illness. Research has focused on the use of communication tools or techniques, characteristics of the communication between patients and clinicians, and their experiences of communication challenges. However, few studies have combined the perspectives of patients, family members, and clinicians. We explored communication from different angles and investigated challenges that cannot be explained by ineffective use of aids and communication techniques.

OBJECTIVES

The aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges.

METHODS

This study used a case-oriented design with multiple triangulations. It was conducted in two general intensive care units at a Norwegian university hospital. Participant observations were conducted on nine mechanically ventilated patients while communicating with family members and healthcare personnel. Following the observations, individual interviews were conducted with six patients, six family members, and nine healthcare personnel.

FINDINGS

Communication often seemed uncomplicated at the time of observations, but information from the interviews revealed another picture. We demonstrate what participants emphasised differently when they discussed their experiences, revealing a discrepancy in perceived importance in the situation. Family members had an important role in interpreting signs from the patient, uncovering challenges that would have been unknown to the nurses otherwise.

CONCLUSIONS

This study illustrates how communication challenges in the intensive care unit may not be perceptible to an observer or to all of the participants involved at the time of the communication. Nurses need to be aware of these communication challenges and realise that the patient might face issues that cannot be easily solved without extensive involvement of the patient, family, and nurses, and perhaps not even until a later stage in the patient's recovery process.

"Loved ones are not 'visitors' in a patient's life"-The importance of including loved ones in the patient's hospital stay: An international Twitter study of #HospitalsTalkToLovedOnes in times of COVID-19

Background

Hospitals are institutions whose primary task is to treat patients. Family-centered care, which considers loved ones as equal partners in patient care, has been gaining recognition in the adult care setting. Our aim was to record experiences of and opinions on communication between hospital-based healthcare providers and patients' loved ones, related but not limited to the rigorous mitigation measures implemented during the COVID-19 pandemic.

Methods

The Twitter profile @HospitalsTalkTo and hashtag #HospitalsTalkToLovedOnes were created to interact with the Twitter public between 7 June 2021 and 7 February 2022. Conversations surrounding #HospitalsTalkToLovedOnes were extracted and subjected to natural language processing analysis using term frequency and Markov chain analysis. Qualitative thematic analysis was performed on the 10% most interacted tweets and of tweets mentioning "COVID" from a personal experience-based subset.

Results

We collected 4412 unique tweets made or interacted by 7040 Twitter users from 142 different countries. The most frequent words were patient, hospital, care, family, loved and communication. Thematic analysis revealed the importance of communication between patients, patients' loved ones and hospitals; showed that patients and their loved ones need support during a patient's hospital journey; and that pediatric care should be the gold standard for adult care. Visitation restrictions due to COVID-19 are just one barrier to communication, others are a lack of phone signal, no space or time for asking questions, and a complex medical system. We formulate 3 recommendations to improve the inclusion of loved ones into the patient's hospital stay.

Conclusions

"Loved ones are not 'visitors' in a patient's life". Irrespective of COVID-19, patient's loved ones need to be included during the patient's hospital journey. Transparent communication and patient empowerment increase patient safety and improve the hospital experience for both the patients and their loved ones. Our findings underline the need for the concept of family-centered care to finally be implemented in adult nursing clinical practice.

Oncology healthcare professionals' knowledge, attitudes, and practices regarding young carers

OBJECTIVE

Increasing numbers of youths are facing a relative's cancer. In this context, some are required to provide significant support and are called young carers (YCs). However, little is known about how these youth are viewed and supported by health professionals. The aim of this study was to investigate the knowledge, attitudes, and practices of oncology healthcare professionals regarding YCs.

METHODS

Thirty-one oncology professionals working in France (adult and pediatric departments and homecare services) participated in semi-structured interviews.

RESULTS

The results indicated that almost all professionals had already met a YC and could identify several situations in their professional context. Their knowledge of YCs appeared to influence their attitudes and practices. They perceived this situation in a rather superficial way when their discourse and ideas were explored in-depth. They mentioned some ideas for improving support for YCs, but also many barriers.

CONCLUSION

The results highlight a moderate level of awareness. Thus, it is necessary to enhance providers' awareness and knowledge of YCs.

PRACTICE IMPLICATIONS

Awareness campaigns and training programs need to be developed for oncology healthcare professionals to help them better identify, understand, and support YCs and their families. This type of action would positively impact patient care.

Evidence-informed consensus statements to guide COVID-19 patient visitation policies: results from a national stakeholder meeting

PURPOSE

Hospital policies forbidding or limiting families from visiting relatives on the intensive care unit (ICU) has affected patients, families, healthcare professionals, and patient- and family-centered care (PFCC). We sought to refine evidence-informed consensus statements to guide the creation of ICU visitation policies during the current COVID-19 pandemic and future pandemics and to identify barriers and facilitators to their implementation and sustained uptake in Canadian ICUs.

METHODS

We created consensus statements from 36 evidence-informed experiences (i.e., impacts on patients, families, healthcare professionals, and PFCC) and 63 evidence-informed strategies (i.e., ways to improve restricted visitation) identified during a modified Delphi process (described elsewhere). Over two half-day virtual meetings on 7 and 8 April 2021, 45 stakeholders (patients, families, researchers, clinicians, decision-makers) discussed and refined these consensus statements. Through qualitative descriptive content analysis, we evaluated the following points for 99 consensus statements: 1) their importance for improving restricted visitation policies; 2) suggested modifications to make them more applicable; and 3) facilitators and barriers to implementing these statements when creating ICU visitation policies.

RESULTS

Through discussion, participants identified three areas for improvement: 1) clarity, 2) accessibility, and 3) feasibility. Stakeholders identified several implementation facilitators (clear, flexible, succinct, and prioritized statements available in multiple modes), barriers (perceived lack of flexibility, lack of partnership between government and hospital, change fatigue), and ways to measure and monitor their use (e.g., family satisfaction, qualitative interviews).

CONCLUSIONS

Existing guidance on policies that disallowed or restricted visitation in intensive care units were confusing, hard to operationalize, and often lacked supporting evidence. Prioritized, succinct, and clear consensus statements allowing for local adaptability are necessary to guide the creation of ICU visitation policies and to optimize PFCC.

Associations Between Family Member Involvement and Outcomes of Patients Admitted to the Intensive Care Unit: Retrospective Cohort Study

BACKGROUND

Little is known about family member involvement, by relationship status, for patients treated in the intensive care unit (ICU).

OBJECTIVE

Using documentation of family interactions in clinical notes, we examined associations between child and spousal involvement and ICU patient outcomes, including goals of care conversations (GOCCs), limitations in life-sustaining therapy (LLST), and 3-month mortality.

METHODS

Using a retrospective cohort design, the study included a total of 858 adult patients treated between 2008 and 2012 in the medical ICU at a tertiary care center in northeastern United States. Clinical notes generated within the first 48 hours of admission to the ICU were used with standard machine learning methods to predict patient outcomes. We used natural language processing methods to identify family-related documentation and abstracted sociodemographic and clinical characteristics of the patients from the medical record.

RESULTS

Most of the 858 patients were White (n=650, 75.8%); 437 (50.9%) were male, 479 (55.8%) were married, and the median age was 68.4 (IQR 56.5-79.4) years. Most patients had documented GOCC (n=651, 75.9%). In adjusted regression analyses, child involvement (odds ratio [OR] 0.81; 95% CI 0.49-1.34; P=.41) and child plus spouse involvement (OR 1.28; 95% CI 0.8-2.03; P=.3) were not associated with GOCCs compared to spouse involvement. Child involvement was not associated with LLST when compared to spouse involvement (OR 1.49; 95% CI 0.89-2.52; P=.13). However, child plus spouse involvement was associated with LLST (OR 1.6; 95% CI 1.02-2.52; P=.04). Compared to spouse involvement, there were no significant differences in the 3-month mortality by family member type, including child plus spouse involvement (OR 1.38; 95% CI 0.91-2.09; P=.13) and child involvement (OR 1.47; 95% CI 0.9-2.41; P=.12).

CONCLUSIONS

Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Early child plus spouse involvement was associated with LLST, suggesting that decisions about LLST were more likely to occur when the child and spouse were both involved compared to the involvement of only the spouse. More research is needed to further understand the involvement of different family members in ICU care and its association with patient outcomes.

Survey on the effectiveness of telephone-based communication with relatives of hospitalized cancer patients in COVID-19 era in Italy

Objective

Methods

Results

Conclusion

Family participation in essential care activities: Needs, perceptions, preferences, and capacities of intensive care unit patients, relatives, and healthcare providers—An integrative review

BACKGROUND

Family participation in essential care activities may benefit both patients and relatives.

OBJECTIVES

In this integrative review, we aimed to identify needs, perceptions, preferences, and capacities regarding family participation in essential care in intensive care units (ICUs) from the patient's, relatives', and ICU healthcare providers' perspective.

REVIEW METHOD USED

An integrative review method was used.

DATA SOURCES

PubMed, CINAHL, EMBASE, MEDLINE, Cochrane, Web of Science, and reference lists of included articles were searched, from inception to January 25, 2021.

REVIEW METHODS

We included studies on family participation in essential care activities during ICU stay which reported associated needs, perceptions, preferences and capacities. Quality assessment was performed with the Kmet Standard Quality Assessment Criteria developed for evaluating primary research papers in a variety of fields, and an extensive qualitative thematic analysis was performed on the results.

RESULTS

Twenty-seven studies were included. Quality scores varied from 0.45 to 0.95 (range: 0-1). Patients' needs, perceptions, preferences, and capacities are largely unknown. Identified themes on needs and perceptions were relatives' desire to help the patient, a mostly positive attitude among all involved, stress regarding patient safety, perceived beneficial effects, relatives feeling in control-ICU healthcare providers' concerns about loss of control. Preferences for potential essential care activities vary. Relatives want an invitation and support from ICU healthcare providers. Themes regarding capacities were knowledge, skills, education and training, and organisational conditions.

CONCLUSIONS

Implementation of family participation in essential care requires education and training of relatives and ICU healthcare providers to address safety and quality of care concerns, though most studies lack further specification.

Impact of a resident and student-led video visitation navigation program

BACKGROUND

Many institutions implemented telehealth initiatives to provide social support for patients during the SARS-CoV-2 (COVID-19) pandemic. Little is known about the impact of these programs on patient support persons and the trainees who facilitated them.

OBJECTIVE

To assess perceptions of a resident physician and medical student-driven video visit program.

METHODS

We designed and implemented a trainee-led video visit navigation program across three affiliated urban hospitals to facilitate video visits between patients and their support persons. We used descriptive statistics to understand the patient population served by the program and employed surveys for support persons and trainees to assess attitudes on the program.

RESULTS

From April to June 2020, a total of 443 video visits were completed. Surveys were conducted for 101 out of 184 (54.9%) support persons and 39 out of 65 (60.0%) of medical trainees. Surveys demonstrated that video visits helped alleviate the stress and anxiety of support persons having a hospitalized loved one they could not visit. For trainees, facilitating these connections helped mitigate stress and provided a mechanism to contribute to the pandemic response.

CONCLUSION

Telehealth navigation programs provide high levels of connection for patients and their support persons during the COVID-19 pandemic and potentially beyond. Residents and medical students involved in these initiatives mobilized telehealth modalities to improve experiences with care delivery.

Experiences and Needs of Patients and Relatives During Hospitalization in an Intensive Care Unit in China: A Qualitative Study

INTRODUCTION

In comparison with Western cultures, the closed management system makes it difficult to implement family-centered nursing in many intensive care unit (ICU) in China. There are differences in cultural cognition and social environment between China and the West. The purpose of this study was to explore the experience and needs of critically ill patients and their relatives from a Chinese cultural perspective.

METHOD

This was a qualitative study using semistructured interviews conducted in a 26-bed integrated ICU at a Tertiary Grade A comprehensive hospital in Nantong, China. The participants included patients admitted in the ICU and their relatives. We used Colaizzi's seven-step procedure to analyze interview data.

FINDINGS

A total of 15 participants were recruited. Main categories within the patient perspective were variety of feelings, staff assistance required, and expectations for relatives. Patient opinions differed about the feelings of hospitalization and whether they needed the help of staff and relatives. The main categories from the relatives' perspective were life is disrupted, information needs, and emotional needs. Relatives of patients in the ICU experienced a lot of physical and mental pressure. The lack of timely understanding of the patient's condition and needs made them feel anxious.

CONCLUSION

The closed management system currently used in China limits contact between ICU patients and their relatives, increasing their physical and emotional discomfort. Hospitals in China should consider updating to a more open visiting policy based on current guidelines for family-centered care. Such policies enable staff to continue providing quality care for their patients while addressing patient and family needs.

The Role of a Liaison Team in ICU Family Communication During the COVID 19 Pandemic

CONTEXT

In the name of public safety, a general suspension on hospital visiting was imposed in the U.K., prohibiting family and friends to visit hospitalized patients, even if they were critically ill.

OBJECTIVES

we aimed to assess the impact of the FLT on the communication with patients' family and friends (PFF), especailly around end-of-life care, and their interaction with CC clinicians.

METHODS

A retrospective, mixed-methods analysis of a family liaison team (FLT) formed by redeployed clinicians in critical care (CC) during the first surge of the 2020 COVID 19 pandemic.

RESULTS

The FLT was constituted predominantly of non-ICU consultants (30/39, 77%). Following two one-hourly webinars around basic communication skills, the FLT facilitated over 12,000 video and telephone calls with 172 patients' family and friends (PFF). The majority of the PFF interviewed were mostly, very or extremely satisfied with the frequency, ease, understanding, honesty, completeness, and consistency of the information provided. Approximately 5% of the interviewees reported to be slightly or very dissatisfied in one or more of the following 3 categories: frequency, consistency, and ease of getting the information. The thematic analysis identified 3 themes: 1) being there with/ for the patient; 2) breakdown in communication; 3) disbelief at the speed of deterioration. In 14.9% of cases there was documented discrepancy between the information transmitted by the CC team and that by the FLT, particularly around the severity of the patient's illness and their imminent death.

CONCLUSION

The formation of a dedicated FLT was feasible and associated with high levels of satisfaction by the PFF. Friction was created when communication was not consistent and did not convey the severity of the patient's condition, to prepare the PFF for a bad outcome.

Defining Familial Interactions and Networks: An Exploratory Qualitative Study on Family Networks and Surrogate Decision-Making

Supplemental Digital Content is available in the text.

OBJECTIVES:

To characterize patient preferences for medical surrogate decision-makers in the ICU to capture the complexity of decision-making preferences and highlight potential conflicts between patients’ preferences and clinicians’ surrogate decision-maker identification in usual clinical practice.

DESIGN:

Prospective qualitative cross-sectional study.

SETTING:

Two ICUs in a quaternary referral center in the eastern United States.

PATIENTS:

Convenience sample of patients admitted to the ICU and their family members.

INTERVENTION:

None.

MEASUREMENTS AND MAIN RESULTS:

Twenty-six patient-family-clinician units were interviewed. Men were three times more likely than women to have a legally appointed decision-maker that matched their preferred decision-maker as expressed in the interview. Patients who were married or in a long-term relationship were the most consistent group of respondents, with 94% of them selecting their spouse or partner as the preferred decision-maker. The most common reasons for selecting a surrogate decision-maker were intangible themes such as feeling “known” by that person rather than having prior discussions about specific wishes or advance directives.

CONCLUSIONS:

Asking about a patient’s familial network and qualities they value in a surrogate decision-maker may aid ICU teams in honoring patients’ wishes for surrogate decision-making. This may be an important supplement to accepted legal hierarchies for proxy decision-makers and advance directive documents. Further studies with larger sample sizes could be used to shed light on the nuances of familial and relationship networks of a more diverse population of respondents.

Family Presence and Sleep in the Intensive Care Unit

Sleep is a vital component of health and healing. Hospitalized patients need sleep in order to overcome their illness, and family members of those patients also need restorative sleep. Nurses can assist with both patient's and family member's abilities to obtain nonfragmented sleep. Education is important for families to understand the importance of sleep, and nurses can also supply families with simple comfort measures such as ear plugs, eye masks, and a comfortable sleep location.

Lived Experiences of Family Members of Patients With Severe COVID-19 Who Died in Intensive Care Units in France

IMPORTANCE

During the initial surge of the COVID-19 pandemic, family members were often separated from their loved ones admitted to intensive care units (ICUs), with a potential for negative experiences and psychological burden.

OBJECTIVE

To better understand the experiences of bereaved family members of patients who died in an ICU during the COVID-19 pandemic, from the time of hospital admission until after the patient's death.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study used semistructured, in-depth interviews to collect experiences from bereaved family members of patients who died from severe COVID-19 in 12 ICUs during the first wave of the pandemic in France. Purposeful sampling was used to ensure the diversity of study participants with respect to sex, age, relationship with the patient, and geographic location. All data were collected between June and September 2020, and data analysis was performed from August to November 2020.

MAIN OUTCOMES AND MEASURES

Interviews were conducted 3 to 4 months after the patient's death and were audio-recorded and analyzed using thematic analysis.

RESULTS

Among 19 family members interviewed (median [range] age, 46 [23-75] years; 14 [74%] women), 3 major themes emerged from qualitative analysis. The first was the difficulty in building a relationship with the ICU clinicians and dealing with the experience of solitude: family members experienced difficulties in establishing rapport and bonding with the ICU team as well as understanding the medical information. Distance communication was not sufficient, and participants felt it increased the feeling of solitude. The second involved the patient in the ICU and the risks of separation: because of restricted access to the ICU, family members experienced discontinuity and interruptions in the relationship with their loved one, which were associated with feelings of powerlessness, abandonment, and unreality. The third was regarding disruptions in end-of-life rituals: family members described "stolen moments" after the patient's death, generating strong feelings of disbelief that may lead to complicated grief.

CONCLUSIONS AND RELEVANCE

This qualitative study found that during the initial wave of the COVID-19 pandemic in France, bereaved family members described a disturbed experience, both during the ICU stay and after the patient's death. Specific family-centered crisis guidelines are needed to improve experiences for patients, families, and clinicians experiences.

The intensive care unit visiting study: A multisite survey of visitors

BACKGROUND

Being able to visit a critically ill relative provides comfort to family members and has recognised benefits to the patient. Limited research has been conducted on demographic characteristics and visiting behaviours of family members with a relative in the intensive care unit (ICU).

OBJECTIVES

The objective was to provide an overview of local ICU visitor behaviours and practices across four metropolitan units in Australia.

METHODS

A convenience sample of 440 participants from four ICUs across a metropolitan city in eastern Australia was required for the study. A descriptive 22-item self-report survey was used. Data were collected from four ICUs in a metropolitan city in eastern Australia. Sample characteristics and other variables were analysed using descriptive statistics.

RESULTS

Data collection was undertaken from April 2018 to May 2019. Four hundred sixty-two (n = 462) ICU visitors responded. There were no significant differences between visitor characteristics across the four hospitals. The mean age of the respondents was 49 years, the youngest participant being 18 years and the oldest being 93 years, with most visitors being women (n = 312, 68%). The participants were more likely to be close relatives such as spouses (n = 117, 25%), parents (n = 113, 24%), or children (n = 79, 17%). Visitors reported different methods by which they received information about visiting policies across units and indicated that they would have visited more frequently if able. Although most respondents rated their ICU visiting experience favourably, some reported being frequently asked to leave the patient's bedside impacted their experience.

CONCLUSIONS

This study has highlighted that families want to remain in close proximity when they have a relative in the ICU. Despite visiting hours being flexible, most families visit midmorning so that they can talk with staff. Data captured in this study can be used toward improving the ICU visiting experience for family members.

Psychological effects of remote-only communication among reference persons of ICU patients during COVID-19 pandemic

Background

During COVID-19 pandemic, visits have been prohibited in most French ICUs. Psychological effects, for reference persons (RPs), of remote-only communication have been assessed.

Methods

All RPs of patients referred to ICU for COVID-19 were included. HADS, IES-R, and satisfaction were evaluated at admission, discharge/death, and 3 months. At 3 months, a psychologist provided a qualitative description of RPs’ psychological distress.

Results

Eighty-eight RPs were included. Prevalence of anxiety and depression was 83% and 73% respectively. At 3 months, lower HADS decrease was associated with patient death/continued hospitalization, and/or sleeping disorders in RPs (p < 0.01). Ninety-nine percent RPs felt the patient was safe (9 [7; 10]/10 points, Likert-type scale), confident with caregivers (10 [9; 10]/10 points), and satisfied with information provided (10 [9; 10]/10 points). All RPs stressed the specific-type of “responsibility” associated with being an RP in a remote-only context, leading RPs to develop narrow diffusion strategies (67%) and restrict the array of contacted relatives to a very few and/or only contacting them rarely. 10 RPs (30%) related the situation to a prior traumatic experience.

Conclusion

RPs experienced psychological distress and reported that being an RP in a remote-only communication context was a specific responsibility and qualified it as an overall negative experience.

Trial registration

NCT04385121. Registered 12 May 2020. https://clinicaltrials.gov/.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40560-020-00520-w.

[Involving families in intensive care]

The place of families in intensive care is still too often underestimated. However, the involvement of family members would have multiple benefits for patients, but also for those around them. Family participation is a promising concept that needs to be studied on the ground and on a large scale, in order to prove itself and guide health professionals in their daily practice.

Effect of family presence on stress response after bypass surgery

BACKGROUND

Coronary artery bypass grafting (CABG) is a major surgery that may cause severe surgical stress response (SR). Although the presence of family members in intensive care unit (ICU) is known to benefit intensive care patients socially and emotionally, its effects on surgical SR are unknown.

OBJECTIVES

To investigate the effect of an informed family member (IFM)'s presence in the awakening process in ICU on patients' SR after CABG.

METHODS

A nonrandomized controlled clinical study was completed with a total of 73 patients: 37 patients in the control (CG) and 36 in the intervention group (IG) underwent CABG surgery. In the CG patients, no family members were taken into the ICU during the awakening process and routine care and treatment practices were continued. In the IG patients, besides routine care and treatment practices, an IFM was taken into the ICU during the awakening process in accordance with the research method. Groups were statistically compared in terms of serum cortisol level which is the one of the main indicators of surgical SR, state anxiety, sedative drug requirements, and duration of intubation, sedation, and ICU stay. A p value <0.05 was accepted as statistically significant.

RESULTS

Presence of an IFM in the ICU was found to be effective in decreasing serum cortisol level, state anxiety, sedative drug requirements, and the duration of intubation, sedation, and ICU stay (p<0.05).

CONCLUSIONS

In CABG, the presence of IFM in ICU is effective in reducing SR.

Family participation in physiotherapy-related tasks of critically ill patients: A mixed methods systematic review

PURPOSE

Providing an overview of studies on family participation in physiotherapy-related tasks of critically ill patients, addressing two research questions (RQ): 1) What are the perceptions of patients, relatives, and staff about family participation in physiotherapy-related tasks? and 2) What are the effects of interventions of family participation in physiotherapy-related tasks?

MATERIAL AND METHODS

Qualitative, quantitative and mixed-methods articles were identified using PubMed, Embase and CINAHL. Studies reporting on family participation in physiotherapy-related tasks of adult critically ill patients were included. A convergent segregated approach for mixed-methods reviews was used.

RESULTS

Eighteen articles were included; 13 for RQ1, and 5 for RQ2. The included studies were quantitative, qualitative and mixed-method, including between 8 and 452 participants. The descriptive studies exhibit a general appreciation for involvement of relatives in physiotherapy-related tasks, although most of the studies reported on family involvement in general care and incorporated diverse physiotherapy-related tasks. One study explored the effectiveness of family participation on a rehabilitation outcome and showed that the percentage of patients mobilizing three times a day increased.

CONCLUSION

Positive attitudes were observed among patients, their relatives and staff towards family participation in physiotherapy-related tasks of critically ill patients. However, limited research has been done into the effect of interventions containing family participation in physiotherapy-related tasks.

Integration of family caregivers in delirium prevention care for hospitalized older adults: A case study analysis

AIM

To understand how family caregivers of older adults hospitalized for orthopaedic surgery are integrated by nurses in delirium prevention care.

DESIGN

Multiple case study.

METHODS

The sample consisted of eight cases. Each case comprised an older adult, a family caregiver, and a nurse. Data were collected from September 2017 - April 2018 through various instruments, including semi-structured interviews and family caregiver logs. Within- and across-case analyses were conducted, based on the model of The Care Partner Engagement developed by Hill, Yevchak, Gilmore-Bykovskyi, & Kolanowski (Geriatric Nursing, 35, 2014, 272).

RESULTS

Two themes emerged: (a) family caregivers were engaged in caring for the older adults during their hospital stay, though they had differences in terms of views and needs; and (b) family caregivers communicated with nurses but nurses did not recognize their role and did not integrate them much in care.

CONCLUSION

The presence and availability of family caregivers, their sense of responsibility towards the hospitalized older adults, and their positive effects on them suggest that family caregivers could be integrated more systematically in a care partnership with nurses. Poor integration of family caregivers in delirium prevention care shows that nurse delirium prevention competencies and their relational skills for communicating effectively with family caregivers need to be developed further.

IMPACT

Integrating family caregivers in delirium prevention care for older adults is a challenge for nurses. Family caregivers are engaged during the hospitalization of older adults, though differences and problems exist between the two groups. While there is communication between patients, family caregivers, and nurses, nurses do not recognize the role of family caregivers and hardly integrated them in the delirium prevention care of hospitalized older adults. Nurses must adopt a patient- and family-centred approach. Care and training facilities must make resources available to implement this approach in nursing practice.

Implementation and sustainment strategies for open visitation in the intensive care unit: A multicentre qualitative study

Objective

Open visitation in adult intensive care units has been associated with improved family and patient outcomes. However, worldwide adoption of this practice has been slow and reasons for this are unclear. This study documents barriers and strategies for implementing and sustaining open visitation in adult intensive care units in the United States experienced by nursing leadership.

Research design

Qualitative approach using grounded theory.

Participants

Nurse leaders in adult intensive care units with open visitation.

Setting

Magnet® or Pathway to Excellence® designated hospitals in the United States.

Methods

Semi structured interviews were conducted with 19 nurse leaders from 15 geographically dispersed hospitals. Interviews were recorded, transcribed and imported into Atlas.ti qualitative software for analysis. Grounded theory constant comparison analysis was used for coding and category development.

Findings

The analysis revealed three barriers; nursing attitudes and clinical and nonclinical barriers. Strategies to overcome these barriers were empathy, evidence-based practice, models of care, shared governance, nurse discretion, security and family spaces.

Conclusion

Intensive care nursing leadership experienced distinct barriers and strategies during pre-implementation, implementation and sustainment of open visitation. Other nursing leaders interested in open visitation can use these findings as they plan this transition in their intensive care units.

Is Open Visitation Really "Open" in Adult Intensive Care Units in the United States?

BACKGROUND

Evidence indicates that open visitation in adult intensive care units is a best practice for patient- and family-centered care, and nurses substantially influence such visitation patterns. However, it is unclear whether intensive care units in Magnet and Pathway to Excellence (MPE) facilities nationwide implement this in practice.

OBJECTIVE

To describe current national visitation practices in adult intensive care units and determine whether they have changed since the last national study, which used data from 2008 to 2009.

METHODS

From February through April 2018, websites of MPE hospitals were reviewed in order to identify their adult intensive care unit visitation policy. If this information was unavailable online, the hospital was telephoned to obtain the policy. From May through August 2018, follow-up telephone calls were made to hospitals that reported open visitation, during which intensive care unit nurses at the hospitals were asked to verify that the policy did not restrict visiting hours or the number, type, or age of visitors.

RESULTS

Among the 536 MPE hospitals contacted, 51% (n = 274) indicated that they allowed open visitation. Further examination, however, revealed that 64% (n = 175) restricted the number (68.2%), age (59.5%), or type (4.4%) of visitors, or visiting hours (19.8%). Only 18.5% of MPE hospitals (n = 99) allowed unrestricted visitation.

CONCLUSION

This study suggests a lack of progress toward implementing open visitation in adult intensive care units nationwide. Research on MPE hospitals that have adopted truly open visitation policies is needed to identify successful methods for implementing and sustaining open visitation.

Family participation in the care of older adult patients admitted to the intensive care unit: A scoping review

BACKGROUND

Family members' participation in care is internationally advocated as a way to improve patient outcomes admitted to the intensive care unit (ICU).

OBJECTIVE

to provide an overview of current understandings about family participation in the care of older adult patients admitted to ICU.

DESIGN, DATA SOURCES, AND METHODS

The Arksey and O'Malley's framework for scoping review was used. We searched PubMed, CINAHL, EmBase, Scopus, and Cochrane from their inception until 10 October 2019 to answer this question: What are the dimensions, prerequisites, facilitators, barriers, and consequences of family member's participation in the care of older adult patient admitted to ICU?

RESULTS

Of 3410 search results, 33 articles were included (10 descriptive; 3 interventional or quality improvement project; 12 qualitative; 5 reviews; 1 expert opinion; 1 evidence-practice recommendation and 1 clinical guideline). The included studies were conducted internationally (n = 7), USA (n = 8), Canada (n = 3), France (n = 2), Britannia, Australia (n = 6), (n = 2), and Sweden (n = 5). No article from Asian and African countries was retrieved. The supporting level of evidence for most studies (28 out of 33) was low.

CONCLUSIONS

This review showed that family members could participate in the provision of physical and non-physical care (emotional, mental, cognitive, and psychosocial) to older adult patients admitted to ICU. Their participation in ICU care has the potential to improve the physical, emotional, psychological and psychological outcomes of older adult patients and their family members as well as reduce the burden of the healthcare system. The barriers were grouped into patient-related factors, ICU staff-related factors, family-related factors, and ICU setting-related factors. In addition, several facilitators of participation in ICU care were discussed.

THE IMPLICATION FOR FUTURE RESEARCH

This review showed a lack of experimental studies on the effectiveness of family members' participation in ICU care for the patient, family, and care system. This provides an opportunity for future research to develop and test interventions based on the multiple dimensions described in this paper.

Family Care Rituals in the ICU to Reduce Symptoms of Post-Traumatic Stress Disorder in Family Members-A Multicenter, Multinational, Before-and-After Intervention Trial

OBJECTIVES

To assess the feasibility and efficacy of implementing "Family Care Rituals" as a means of engaging family members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress-related symptoms in family members.

DESIGN

Prospective, before-and-after intervention evaluation.

SETTING

Two U.S. academic medical ICU's, and one Italian academic medical/surgical ICU.

SUBJECTS

Family members of patients who had an attending predicted ICU mortality of greater than 30% within the first 24 hours of admission.

INTERVENTIONS

A novel intervention titled "Family Care Rituals" during which, following a baseline observation period, family members enrolled in the intervention phase were given an informational booklet outlining opportunities for engagement in care of the patient during their ICU stay.

MEASUREMENTS AND MAIN RESULTS

Primary outcome was symptoms of post-traumatic stress disorder in family members 90 days after patient death or ICU discharge. Secondary outcomes included symptoms of depression, anxiety, and family satisfaction. At 90-day follow-up, 131 of 226 family members (58.0%) responded preintervention and 129 of 226 family members (57.1%) responded postintervention. Symptoms of post-traumatic stress disorder were significantly higher preintervention than postintervention (39.2% vs 27.1%; unadjusted odds ratio, 0.58; p = 0.046). There was no significant difference in symptoms of depression (26.5% vs 25.2%; unadjusted odds ratio, 0.93; p = 0.818), anxiety (41.0% vs 45.5%; unadjusted odds ratio, 1.20; p = 0.234), or mean satisfaction scores (85.1 vs 89.0; unadjusted odds ratio, 3.85; p = 0.052) preintervention versus postintervention 90 days after patient death or ICU discharge.

CONCLUSIONS

Offering opportunities such as family care rituals for family members to be involved with providing care for family members in the ICU was associated with reduced symptoms of post-traumatic stress disorder. This intervention may lessen the burden of stress-related symptoms in family members of ICU patients.

Family INvolvement in inTensive care: A qualitative exploration of critically ill patients, their families and critical care nurses (INpuT study)

AIMS AND OBJECTIVES

To understand the different factors that impact on the involvement of adult family members in the care of critically ill patients from the perspective of patients, families and nurses, with the aim to inform the enactment of a patient- and family-centred care intervention to support the patient-family-nurse partnership in care involvement.

BACKGROUND

Existing evidence lacks theoretical underpinning and clarity to support enactment of patient- and family-centred care and involvement of families in the care of the critically ill patient.

DESIGN

Qualitative exploratory design using thematic analysis.

METHODS

This study was conducted at two adult intensive care units in two tertiary university hospitals in the central belt of Scotland. Between 2013-2014, we conducted semi-structured interviews with critically ill survivors (n = 19) and adult family members (n = 21), and five focus groups with nurses (n = 15) across both settings. Data were digitally recorded, transcribed verbatim, and uploaded in NVivo 10. Data were analysed thematically using a constructivist epistemology. Ethical approval was obtained prior to data collection. Data are reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.

RESULTS

Family's situational awareness; the perceived self in care partnership; rapport and trust; and personal and family attributes were the main factors that affected family involvement in care. Two key themes were identified as principles to enact patient- and family-centred care in adult intensive care units: "Need for 'Doing family'" and "Negotiations in care involvement."

CONCLUSIONS

Negotiating involvement in care requires consideration of patients' and family members' values of doing family and the development of a constructive patient-family-nurses' partnership.

RELEVANCE TO CLINICAL PRACTICE

Future policy and research should consider patients' and family's needs to demonstrate family bonds within a negotiated process in care participation, when developing tools and frameworks to promote patient- and family-centred care in adult intensive care units.

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.

Measuring the quality of inpatient specialist consultation in the intensive care unit: Nursing and family experiences of communication

Rationale

Critically ill patients in the intensive care unit (ICU) often require the care of specialist physicians for clinical or procedural expertise. The current state of communication between specialist physicians and families and nurses has not been explored.

Objectives

To document the receipt of communication by nurses and family members regarding consultations performed on their patient or loved one, and to quantify how this impacts their overall perceptions of the quality of specialty care.

Methods

Prospective survey of 60 adult family members and 90 nurses of 189 ICU patients who received a specialist consultation between March and October of 2015 in a single academic medical center in the United States. Surveys measured the prevalence of direct communication—defined as communication conducted in person, via telephone, or via text-page in which the specialist team gathered information about the patient from the nurse/family member and/or shared recommendations for care—and perceived quality of care.

Results

In about two-thirds of family surveys (40/60) and one-half of nurse surveys (75/160), respondents had no direct communication with the specialist team that performed the consultation. Compared to nurses who had no direct communication with the specialists, those who did were 1.5 times more likely to rate the consultation as “excellent” (RR 1.48, 95% CI 1.2–1.8, p<0.001). Nearly 40% (22/60) of families knew so little about the consultation that they felt incapable of evaluating it.

Conclusions

Most ICU families and nurses have no interaction with specialist providers. Nurses’ frequent exclusion from conversations about specialty care may pose safety risks and increase the likelihood of mixed messages for patients and families, most of whom desire some interaction with specialists. Future research is needed to identify effective mechanisms for information sharing that keep nurses and families aware of consultation requests, delivery, and outcomes without increasing the risk of mixed messages.

A multicase study of prolonged critical illness in the intensive care unit: Families' experiences

BACKGROUND

It is widely acknowledged a critical illness is a stressful life event for not only the patient but also their family members; when an illness becomes prolonged, the impact is profound. It is suggested that as medical technologies advance, the number of days patients stay in an intensive care unit will increase. Therefore, it is important nurses understand how families experience a prolonged critical illness of their family member in an intensive care unit.

OBJECTIVE

To explore the trajectory of a prolonged critical illness in the intensive care unit from the experiences of family.

METHODS

A qualitative, longitudinal, multi-case design consisting of six cases from New Zealand intensive care units. Findings presented in this article only relate to the family's experiences, although patients and healthcare professionals formed part of each case. Data collection methods included observation, conversations, interviews and document review. Analysis was undertaken using thematic analysis, vignette development and trajectory mapping.

FINDINGS

Relentless uncertainty dominated all phases of the trajectory for the family during a family member's prolonged critical illness in the intensive care unit. When faced with a critical illness, family shifted rapidly into a world of unknowns. Family worked hard to navigate their way through the many uncertainties that dominated each phase of their family member's illness.

CONCLUSIONS

Nurses need to understand the levels of uncertainty families endure in order to provide care that meets the philosophical underpinnings of family centred care.

Perceptions of Family Members, Nurses, and Physicians on Involving Patients' Families in Delirium Prevention

BACKGROUND

Delirium occurs in up to 80% of patients admitted to an intensive care unit. Nonpharmacologic delirium-prevention strategies, which are commonly used by the bedside nurse, have reduced the incidence and duration of delirium in patients in the intensive care unit. With increasing demands on the nurse, strategies such as including the patient's family in delirium prevention activities should be investigated. OBJECTIVE To determine opinions and willingness of health care providers to involve patients' families in nonpharmacologic delirium-prevention activities in the intensive care unit, and of patients' families to be involved.

METHODS

Two surveys, one for intensive care unit nurses and physicians and one for patients' families, were developed and administered. The provider survey focused on current delirium-prevention practices and opinions about family involvement. The family survey concentrated on barriers and willingness to participate in prevention activities.

RESULTS

Sixty nurses and 58 physicians completed the survey. Most physicians (93%) and all nurses believed families could assist with delirium prevention. Only 50% reported speaking with family members about delirium and delirium prevention. The family survey was completed by 60 family members; 38% reported a provider spoke with them about delirium. Family members reported high levels of comfort in participating in delirium-prevention activities.

CONCLUSIONS

Health care providers and family members are supportive of the latter performing delirium-prevention activities. Family of patients in the intensive care unit may work collaboratively with nurses to reduce the incidence and duration of delirium in these patients.

Prioritizing information topics for relatives of critically ill patients : Cross-sectional survey among intensive care unit relatives and professionals

A patient’s admission to an intensive care unit (ICU) has a significant impact on family members and other relatives. In order for them to be able to cope with such a stressful situation, the availability of appropriate understandable and accessible information is crucial. The information asymmetry between relatives and medical professionals may adversely affect satisfaction of relatives and their risk of subsequent anxiety, depression and stress symptoms. The aim of this study was therefore to understand which topics are most important to the relatives of ICU patients and to quantify the perceptions of medical professionals regarding the information needs of relatives. A cross-sectional survey was conducted in 2015. The survey had 42 questions, such as ‘diagnosis’, ‘treatment’, ‘comfort’, ‘family’ and ‘end of life’. In total, the survey was handed out to four different groups. A total of 336 persons answered the survey (26 relatives, 28 ICU physicians, 202 ICU nurses and 80 ICU medical professionals in a closed Facebook© group [Facebook, Menlo Park, California, USA]). Relatives ranked the five most important topics as follows: ‘recent events (crisis)’, ‘my participation’, ‘contamination in hospital’, ‘physical pain’, and ‘probability’. Several significant differences (p<0.001) were detected, for example for the topics fever, medication, recent events (crisis), appointments, relapse, and investigations. Even the topic with the lowest ranking (religion) had a score of 3.15 (min. 1.00, max. 5.00) among relatives. The ICU professionals appear to have divergent opinions regarding the most important topics for ICU relatives as compared to relatives themselves.

Implementing the SCCM Family-Centered Care Guidelines in Critical Care Nursing Practice

Family-centered care is an important component of holistic nursing practice, particularly in critical care, where the impact on families of admitted patients can be physiologically and psychologically burdensome. Family-centered care guidelines, developed by an international group of nursing, medical, and academic experts for the American College of Critical Care Medicine/Society of Critical Care Medicine, explore the evidence base in 5 key areas of family-centered care. Evidence in each of the guideline areas is outlined and recommendations are made about how critical care nurses can use this information in family-centered care practice.

[Communicating with families in the ICU : Background and practical recommendations]

Family members of adult intensive care patients are partners of the interdisciplinary team. Family members provide important contributions to patient-centered care in the intensive care unit (ICU) and beyond. At the same time, family members are stressed and are themselves in need of support ("family-centered care"). This is mainly provided through family conferences. Family members must always be treated respectfully and with consideration for their acute stress syndrome. A structured communication is recommended as well as written standard operating procedures (SOPs) or guidelines for the ICU team and brochures and written guidelines for relatives. Documentation of structured family conferences is an established quality indicator of intensive care.

Reducing pressure ulcers in patients with prolonged acute mechanical ventilation: a quasi-experimental study

Objective:

To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients.

Methods:

This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle".

Results:

Fifty-five patients were included in Pre-I group, and 69 were included in the Post-I group, and the incidence of pressure ulcers in these groups was 41 (75%) and 37 (54%), respectively. The median time for pressure ulcers to develop was 4.5 [4 - 5] days in the Pre-I group and 9 [6 - 20] days in the Post-I group after admission for each period. The incidence of advanced-grade pressure ulcers was 27 (49%) in the Pre-I group and 7 (10%) in the Post-I group, and finally, the presence of pressure ulcers at discharge was 38 (69%) and 18 (26%), respectively (p < 0.05 for all comparisons). Family participation totaled 9% in the Pre-I group and increased to 57% in the Post-I group (p < 0.05). A logistic regression model was used to analyze the predictors of advanced-grade pressure ulcers. The duration of mechanical ventilation and the presence of organ failure were positively associated with the development of pressure ulcers, while the multifaceted intervention program acted as a protective factor.

Conclusion:

A quality program based on both a smartphone application and family participation can reduce the incidence and severity of pressure ulcers in patients on prolonged acute mechanical ventilation.

Family Perceptions of Family Nursing in a Magnet Institution During Acute Hospitalizations of Older Adult Patients

Family involvement during hospitalizations of older adults with chronic illnesses may benefit both patients and family. However, there is a limited amount of research focused on families of older adults managing chronic illness. This study describes family member perceptions of the relationship between family and nurses when an older adult with diabetes is hospitalized in a Magnet institution. The Calgary Family Intervention Model guided the study. A family member of 60 older adult patients completed the Family Function, Family Health, and Social Support Instrument. The results revealed positive perceptions from family members regarding their perceptions of family nursing practice. Family health, however, was found to decrease slightly as loved ones are hospitalized more frequently, and is an area where nurses may provide improved social support. Future research might target the implementation of a targeted family-level intervention designed to improve family outcomes as well as family nursing practice.

Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis

OBJECTIVE

To determine whether patient- and family-centered care interventions in the ICU improve outcomes.

DATA SOURCES

We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016.

STUDY SELECTION

We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs.

DATA EXTRACTION

We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes.

DATA SYNTHESIS

There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95-1.21; p = 0.27; I = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, -2.25 to -0.16; p = 0.02; I = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis.

CONCLUSIONS

Patient- and family-centered care-focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting.

A Review of the Perceptions of Healthcare Providers and Family Members Toward Family Involvement in Active Adult Patient Care in the ICU

OBJECTIVE

The objective of this article is to provide a summary of the perceptions of healthcare providers and family members toward their role in active patient care in the ICU and compare the views of healthcare providers with those of relatives of critically ill patients.

DATA SOURCES

The search was conducted using PubMed as the primary search engine and EMBASE as a secondary search engine.

STUDY SELECTION

Studies were included if they were conducted in the ICU, had an adult patient population, and contained a discussion of active patient care, including perspective or actions of family members or healthcare providers about the active participation.

DATA EXTRACTION

Titles and abstracts of articles identified through PubMed and EMBASE were assessed for relevancy of family involvement. The full article was reviewed of titles and abstracts involving family involvement of care in the ICU to assess if the topic was active care and if the article involved perceptions of healthcare providers or family members. The references of all selected articles were then evaluated for the inclusion of additional studies.

DATA SYNTHESIS

Articles including perceptions of healthcare providers were grouped separately from articles including attitudes of family members. Articles that contained the perceptions of both healthcare providers and family members were considered in both groups but were evaluated with each perspective separately. Examples of specific patient care tasks that were mentioned in each article were identified.

CONCLUSIONS

A positive attitude exists among both family members and providers toward the involvement of family members in active care tasks. Providers and family members share the attitude that a partnership is necessary and that encouragement for family members to participate is essential. The findings in this review support the need for more objective research regarding how families are caring for their loved ones and how family involvement in care is affecting patient and family outcomes.

Family Presence in the Adult ICU During Bedside Procedures

PURPOSE

To understand perspectives of family members of adult patients admitted to the medical-surgical intensive care unit (ICU) regarding their presence during procedures.

METHODS

Respondents completed a questionnaire about procedures the patient had undergone, their desire to be present, and their experience. Procedures of interest were endotracheal intubation; chest compressions; vascular catheter insertion; and gastric, chest, and rectal tubes. Impact of Events Scale-Revised (IES-R) was completed at the time of questionnaire completion and again 1 month later to evaluate the psychological impact of witnessing a procedure.

RESULTS

Ninety-seven respondents completed the questionnaire on behalf of 72 patients. More than 90% patients had at least 1 procedure. Only 29 (30%) family members were present for at least 1 procedure, and 44% to 100% wished to be present. Of the 68 respondents not present for a procedure, 18 (26.5%) wanted to be present. The IES-R was completed by 52 (95%) of 55 respondents who witnessed any procedure at time 1 and 28 (51%) of 55 respondents at time 2; mean IES-R scores were 8.0 and 8.8 ( P = .68), respectively. Only 2 participants had IES-R >33, signifying the likely presence of posttraumatic stress disorder.

CONCLUSION

Family members wish to be present for ICU procedures, and there are no adverse psychological effects.

[Communication, information, and roles of parents in the pediatric intensive care unit: A review article]

Pediatric intensive care units (PICUs), whose accessibility to parents raises controversy, often operate under their own rules. Patients are under critical and unstable conditions, often in a life-threatening situation. In this context, the communication with the parents and their participation in the unit may be difficult. Information is a legal, deontological, and moral duty for caregivers, confirmed by the parents' needs. But the ability to enforce them is a challenge, and there is a gap between the theory and the reality. The communication between the parents and the physicians starts at the admission of the child with a family conference. According to the Société de réanimation de langue française (SRLF), the effectiveness of the communication is based on three criteria: the patients' comprehension, their satisfaction and their anxiety and depression. It has been shown that comprehension depends on multiple factors, related on the parents, the physicians, and the medical condition of the child. Regarding the parents' participation in the organization of the service, the parents' presence is becoming an important factor. In the PICU, the parents' status has evolved. They become a member of the care team, as a partner. The best interest of the child is always discussed with the parents, as the person knowing the best their child. This partnership gives them a responsibility, which is complementary to the physician's one, but does not substitute it.