The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey

Educational programs to improve nursing competency of patient- and family-centered care in intensive care units: A systematic review

BACKGROUND

As the need for and value placed on patient- and family-centered care (PFCC) has increased worldwide, the importance of nursing competency to perform PFCC has grown, and education on this topic is also emphasized. However, little is known about the components of educational programs for intensive care unit (ICU) nurses based on the person-centered nursing theoretical framework and outcome indicators. The aim of this systematic review was to determine how the educational components of PFCC for nurses were implemented based on the person-centered nursing theoretical framework and to identify educational outcome indicators for ICU nurses.

STUDY DESIGN

We searched five electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, and RISS) from 2001 to May 4, 2024, for studies of educational programs on PFCC for nurses in ICUs. The authors independently screened and extracted the data, and three authors appraised the results. The contents of educational programs of PFCC for nurses were examined. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool.

RESULTS

Overall, 2162 records were identified, and 5 full-text articles were assessed. All studies included the professional competency of knowledge about PFCC or evidence-based practice as well as communication skill with families as an aspect of interpersonal skills. However, the domains of self-awareness and clarity of values and beliefs were not identified, and collaboration was lacking. Three studies evaluated the level of family nursing practice, and two of these reported improvements.

CONCLUSIONS

This review suggests that a PFCC educational program may be effective in improving the PFCC competencies of ICU nurses. Further research is needed to address knowledge gaps related to self-awareness, clarity of beliefs and values, and collaboration. The results from this review can be used to inform future curriculum design and the content of PFCC educational programs for nurses in the ICU.

Waiting to be discharged from intensive care units: Key factors shaping patient and family experiences

OBJECTIVES

To explore the factors that facilitate and hinder intensive care unit (ICU) discharge processes related to patients and their family members.

METHODS

This was a qualitative exploratory study conducted in three regional adult ICUs in Queensland, Australia. Data were collected through semi-structured interviews with patients and their family members (or patient representatives) in addition to daily reflections based on direct observation. A deductive content analysis was undertaken using the Structure, Process, and Outcomes framework, followed by an inductive approach to generate themes.

RESULTS

A total of 16 participants participated in interviews, involving 14 patients, one family member, and one patient representative. Four themes included a desire to be involved, being kept informed, uncertainty in waiting, and the discharge rush. Participants spoke about the desire to be involved in their care and discharge transition. There was a prevailing tension among patients about being kept informed. Although participants remarked that staff communication was reassuring, supportive, and comforting, they noted that timelines for discharge were often unclear, causing hesitation in the discharge process and minimal information before a sudden transfer. Uncertainty in waiting was frequently mentioned by the participants and also reflected in the daily reflections. This uncertainty led to consequences, such as discharge against medical advice and after-hours discharge rush.

CONCLUSION

The findings of this study support existing literature that underlines the importance of patient and family involvement in care, effective communication, and coordination during the discharge processes. After-hours discharge rush should be avoided for the safety of the patients and others on the wards.

IMPLICATIONS FOR CLINICAL PRACTICE

Gaining an understanding of patient and family perspectives on the ICU discharge processes can guide clinicians in developing strategies to improve the continuity and quality of care and therefore enhance patient safety during ICU discharge.

Longitudinal trajectories of health-related quality of life among critical care survivors: A latent class growth approach

OBJECTIVES

This study explored the trajectories of health-related quality of life (HRQOL) and the factors influencing these trajectories.

RESEARCH METHODOLOGY/DESIGN

Prospective observational cohort study.

SETTING

19 intensive care units (ICUs) in South Korea.

MAIN OUTCOME MEASURES

We used the Medical Outcomes Study Short Form version 2 (SF-36v2) to assess HRQOL at 3, 6, 12, and 24 months post-discharge. Additionally, we evaluated intensive care experience, post-intensive care syndrome, and demographic and clinical characteristics to identify factors. HRQOL trajectory groups were identified via latent class growth modeling, with determining factors analyzed using multinomial logistic regression.

RESULTS

The analysis identified three distinct groups for the physical component summary (PCS) and mental component summary (MCS) of the SF-36v2. For the PCS, the groups were labeled "Resilient Stable," "Moderate Recovered," and "Slow Recovering." For the MCS, the classifications were "Resilient Stable," "Low Recovered," and "Persistent Low." The determinants of the PCS Moderate Recovered and Slow Recovering Groups included older age, female gender, less educated, increased comorbidities, discharge to extended care facilities, and post-intensive care syndrome. Conversely, the MCS Low Recovered and Persistent Low Groups were determined by the intensive care experience and post-intensive care syndrome.

CONCLUSION

Our study identified specific vulnerable groups for PCS and MCS and their determinants in terms of HRQOL recovery among ICU survivors.

IMPLICATIONS FOR CLINICAL PRACTICE

There is a need for a preemptive approach for survivors with determinants that place them in vulnerable groups for poorer HRQOL as well as systematic monitoring of post-intensive care syndrome in various healthcare settings.

How the nursing work environment moderates the relationship between clinical judgment and person-centered care among intensive care unit nurses

BACKGROUND

Person-centered care focuses on individualized care that respects patients' values, preferences, and autonomy. To enhance the quality of critical care nursing, institutions need to identify the factors influencing ICU nurses' ability to provide person-centered care. This study explored the relationship between clinical judgment ability and person-centered care among intensive care unit (ICU) nurses, emphasizing how the ICU nursing work environment moderates this relation.

METHODS

A cross-sectional survey was conducted between September 4 and September 18, 2023, with 192 ICU nurses recruited from four general hospitals with a convenience sample (valid response rate = 97.4%). Participants completed online self-report structured questionnaires. The collected data were analyzed using hierarchical multiple regression and PROCESS macro Model 1, with a 95% bias-corrected bootstrap confidence interval to verify moderating effects.

RESULTS

Clinical judgment ability (β = .24, p < .001) and ICU nursing work environment (β = .50 p < .001) were found to be significant predictors of person-centered care. These two predictors explained the 47.0% of person-centered care in the final hierarchical regression model. Additionally, Clinical judgment (B = 0.28, p < .001, Boot. 95%CI = 0.13~0.42) and the ICU nursing work environment (B = 0.41, p < .001, Boot. 95%CI = 0.30~0.52) positively affected person-centered care, and the interaction term of clinical judgment and ICU nursing work environment (B = 0.16, p = .026, Boot. 95%CI = 0.02~0.30) also positively affected person-centered care. The moderating effect was particularly significant when the ICU nursing work environment score was 2.90 points (below 14.6%, above 85.4%) or higher on a scale of 1-5 and As the ICU nursing work environment score increased, the positive moderating effect also increased.

CONCLUSIONS

The ICU nurses' clinical judgment ability positively affected person-centered care, and the nursing work environment moderated the relationship between clinical judgment ability and person-centered care. Therefore, strategies for enhancing person-centered care among ICU nurses should focus on developing educational programs to improve clinical judgment ability and implementing comprehensive efforts to effectively improve and manage the nursing work environment.

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

AIM

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

S. S, Begum M, Chakraborty SR, Chowdhury H, Chowdhury MAR, Deb P, Akhter Farzana N, Ghose A, Harun Or Roshid M, Hoque Tipu MR, Hosain S, Hossain MM, Moinul Islam M, Kumar Tirupakuzhi Vijayaraghavan B, Mohsin M, Mund M, Nasrin S, Kumar Nath R, Nayak S, Pani N, Ahmmad Sarker S, Dondorp A, Tripathy S, Faiz MA. Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Patients' experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU.

Measuring the intensive care experience of intensive care unit patients: A cross-sectional study in western China

BACKGROUND

The negative experiences of intensive care unit (ICU) patients seriously affect their quality of life and survival outcomes. Thus, it is of great significance to evaluate the monitoring experience of ICU patients for the clinical improvement of their experiences and promote interventions.

OBJECTIVES

The objective of this study was to investigate patients' experiences of ICU and to understand the sources of patient experience and influencing factors.

METHODS

From November 2021 to September 2022, a cross-sectional survey was conducted with 600 inpatients from four grade A-III hospitals in western China. Data were collected using the Chinese version of the Intensive Care Experience Questionnaire.

RESULTS

585 valid questionnaires were collected, the response rate was 97.5%. ICU patients in western China scored below-the-average for their intensive care experience. Family monthly income, occupation types, medical payment method, type of ICU, ICU admission plan, ICU admission times, mechanical ventilation use, fertility status, analgesia, sedation, and Acute Physiology and Chronic Health Evaluation II scores are important factors influencing ICU patients' intensive care experience.

CONCLUSIONS

Medical staff need to pay attention to patient experience, improve the awareness of patient stressors and influencing factors, design nursing programs conducive to patient-positive experience, and promote interventions to further improve the long-term prognosis of patients. The results of this study can also be used as a set of nursing-sensitive indicators for evaluating nursing structure, process, and outcomes.

Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study

OBJECTIVE

to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not.

METHOD

a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not.

RESULTS

67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures.

CONCLUSION

the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study

OBJECTIVE

to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not.

METHOD

a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not.

RESULTS

67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures.

CONCLUSION

the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.