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Shin JW, Happ MB, Tate JA. VidaTalk™ patient communication application "opened up" communication between nonvocal ICU patients and their family. Intensive Crit Care Nurs 2021; 66:103075. [PMID: 34127362 PMCID: PMC10833611 DOI: 10.1016/j.iccn.2021.103075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To explore family members' perceptions of an electronic communication application, VidaTalk™, their communication experience, and emotional reactions to communication with mechanically ventilated patients in the intensive care units. RESEARCH METHODOLOGY/DESIGN Qualitative phase of a mixed-methods study nested within a randomised controlled trial. Family members in the intervention group received the VidaTalk™ app as a communication aid during their intensive care stay. Seven family members participated in 18 semi-structured email interviews after discharge between May and December 2018. Interviews were analysed using qualitative content analysis. SETTING Families were recruited in multiple intensive care units located in one university hospital. MAIN OUTCOME MEASURES Communication experience with the VidaTalk™ and emotions while communicating with the patient. Basic qualitative description and constant comparative techniques were used to code and analyse the text using ATLAS_ti (Version 7.5.18). FINDINGS The VidaTalk™ opened up family-patient communication by allowing clear communication and expanding communication content. Family members felt happy and thankful to communicate with the patient. They also expressed feelings of relief and less frustration and less stress while communicating with the patient. On the other hand, the patient's ability to express their worries or anxiety sometimes made families feel sad or distressed. CONCLUSION The VidaTalk™ was helpful for family-patient communication. The VidaTalk™ may help families reduce psychological distress. However, expanded communication with critically ill patients may cause other negative feelings.
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Affiliation(s)
- Ji Won Shin
- Betty Irene Moore School of Nursing, University of California - Davis, Betty Irene Moore Hall, 2570 48th St., Sacramento, CA 95817, USA; College of Nursing, The Ohio State University, Newton Hall #352, 1585 Neil Ave., Columbus, OH 43210, USA.
| | - Mary Beth Happ
- College of Nursing, The Ohio State University, Newton Hall #352, 1585 Neil Ave., Columbus, OH 43210, USA.
| | - Judith A Tate
- College of Nursing, The Ohio State University, Newton Hall #352, 1585 Neil Ave., Columbus, OH 43210, USA.
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Valle M, Lohne V. The significance of hope as experienced by the next of kin to critically ill patients in the intensive care unit. Scand J Caring Sci 2020; 35:521-529. [PMID: 32363621 DOI: 10.1111/scs.12864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
AIM To examine and increase understanding of diverse aspects of hope as experienced by the next of kin when someone close to them is critically ill in intensive care unit (ICU). DESIGN A qualitative study with a phenomenological approach. METHOD The data were collected through five in-depth interviews with next of kin at the ICU in Central Norway. Data were interpreted to gain a deeper understanding on hope in an acute and critical context. RESULTS The analysis presents five main themes: (i) hope for survival, (ii) hope is fostered by signs of improvement, (iii) hope keeps fear for the worst at bay, (iv) hope that things will turn out well and (v) hope for the return to a normal life. Hope kept next of kin going during a difficult time and was strengthened when they saw their close family member responding positively to treatment provided by the ICU.
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Affiliation(s)
- Marianne Valle
- Emergency Reseption, Molde Hospital, Molde, Norway.,Departement of Nursing, Oslo Metropolitan University, Oslo, Norway
| | - Vibeke Lohne
- Departement of Nursing, Oslo Metropolitan University, Oslo, Norway
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Vester LB, Dreyer P, Holm A, Lorentzen V. The experience of being a couple during an intensive care unit admission. Nurs Crit Care 2019; 25:238-244. [PMID: 30907502 DOI: 10.1111/nicc.12421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/20/2018] [Accepted: 01/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND In critical care nursing, a trend has been seen towards growing attention to the family experience of critical illness. Despite trends moving towards care of the family as a unit, previous research has focused on individual family members' experience of critical illness. Exploring the life world of the family, especially that of spouses and their interaction, is essential to providing family-centred critical care and has not previously been described. AIM To explore the lived experience of being a couple during admission to an intensive care unit. DESIGN Data were collected through dyadic semi-structured interviews with four couples who had experienced admission to an intensive care unit. Interviews were audio-taped and transcribed verbatim. METHOD Grounded in the phenomenological-hermeneutic tradition, data were analysed using Ricoeur's theory of interpretation, using a method described by Dreyer and Pedersen. RESULTS By way of analysis, the life world of being a couple during admission to an intensive care unit was disclosed and divided into themes: For better and for worse; The meaningful proximity; and Being a couple. CONCLUSION Although critical illness brings a sudden disruption of a couple's twosomeness, the need to remain, act as and be seen and cared for as a couple persists during admission to an intensive care unit. Therefore, couples need to be cared for as individuals and as a unit, underlining the need to follow trends towards family-centred critical care.
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Affiliation(s)
- Louise B Vester
- Department of Intensive Care (East), Aarhus University Hospital, Aarhus, Denmark
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Institute of Public Health, Section for Nursing, University of Aarhus, Aarhus, Denmark
| | - Anna Holm
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke Lorentzen
- Institute of Public Health, Section for Nursing, University of Aarhus, Aarhus, Denmark.,Centre for Research in Clinical Nursing, Viborg, Denmark.,School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
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Kongsuwan W, Borvornluck P, Locsin RC. The lived experience of family caregivers caring for patients dependent on life-sustaining technologies. Int J Nurs Sci 2018; 5:365-369. [PMID: 31406849 PMCID: PMC6626285 DOI: 10.1016/j.ijnss.2018.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/11/2018] [Accepted: 09/19/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to describe the meaning of the lived experience of family caregivers caring for their loved ones who were dependent upon life-sustaining technologies while in the hospital. METHODS This study followed van Manen's hermeneutic phenomenological approach to generate and analyze data to describe the experience of ten family caregivers who met the following inclusion criteria: a family member who participated actively in caring for the loved one who was dependent upon technologies for human care. Data were collected using individual in-depth interviews. The interview transcriptions were analyzed using van Manen's phenomenological approach, while Lincoln and Guba's criteria were used to establish trustworthiness of the study. FINDINGS Four thematic categories structured the meaning of the experience: Being an invisible person; supporting patients' wholeness; struggling to trust technologies for human care; and living in uncertainty. These thematic categories were reflective of Van Manen's four lived worlds of body, relation, space, and time. CONCLUSION Understanding the experience of family caregivers challenges nurses to express their technological competencies in caring more fully in their human care. Locsin's theory of Technological Competency as Caring in Nursing was used to explain and describe the meaning of the experiences of family caregivers caring for patients who were dependent upon technologies for human care, and foster nursing practice as caring in nursing.
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Affiliation(s)
- Waraporn Kongsuwan
- Adult and Elderly Nursing Department, Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Pongpaka Borvornluck
- Medical Equipment Center, Department of Nursing, Songklanagarind Hospital, Faculty of Medicine, Hat Yai, Songkhla, 90112, Thailand
| | - Rozzano C. Locsin
- Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
- Florida Atlantic University, Boca Raton, FL, 33431, USA
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MacEachnie LH, Larsen HB, Egerod I. Children's and young people's experiences of a parent's critical illness and admission to the intensive care unit: A qualitative meta-synthesis. J Clin Nurs 2018; 27:2923-2932. [PMID: 29700880 DOI: 10.1111/jocn.14498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about how children and young people experience and manage the critical illness of a parent and a parent's admission to the intensive care unit (ICU). OBJECTIVE The aim of this study was to search and interpret the existing literature describing children's and young people's experiences of a parent's illness trajectory in the ICU. METHOD A qualitative meta-synthesis was conducted based on a systematic literature search of online databases. FINDINGS Four main themes were identified and synthesised to describe the integrated experiences of children and young people: (a) the parent-child bond, (b) the unfamiliar environment, (c) the impact of the illness and (d) the experience of being overseen as close family members. CONCLUSION Experiencing a parent's critical illness and admittance to the ICU is overwhelming. The bond between the parent and child is exposed by the separation from the ill parent. To comprehend and manage the experience, children and young people seek information depending on their individual capacities. They express a need to be close to their ill parent and to be seen and approached as close members of the family. However, children experience being overseen in their needs for support during their parent's ICU illness with the risk of being left in loneliness, sadness and lack of understanding of the parent's illness. RELEVANCE FOR CLINICAL PRACTICE Children and young people as relatives need to be acknowledged as close members of the family, when facing the illness trajectory of a parent, who is admitted to the ICU. They need to be seen as close family members and to be approached in their needs for support in order to promote their well-being during a family illness crisis. Early supportive interventions tailored to include children of the intensive care patient are recommended.
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Affiliation(s)
- Lise H MacEachnie
- Thoracic Intensive Care Ward, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Ingrid Egerod
- Intensive Care Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Hajiabadi F, Heydari A, Manzari ZS. Enclosed in the synergistic rings of suffering: The experience of conscious patients under mechanical ventilation in the intensive care unit of the causes of suffering. Electron Physician 2018; 10:6697-6706. [PMID: 29881533 PMCID: PMC5984025 DOI: 10.19082/6697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/04/2017] [Indexed: 11/24/2022] Open
Abstract
Background Patients undergoing mechanical ventilation in intensive care units are in a special position of suffering, and discovering their experiences in the painful situations of the intensive care unit can contribute greatly to improve the quality of nursing care for them. Objective The present study was performed aiming to explain the experience of conscious patients receiving mechanical ventilation in the intensive care units of the causes of suffering. Methods This is a qualitative content analysis study conducted in Iran in 2017. Participants of this study included 15 conscious mechanically ventilated patients in the intensive care unit. Semi-structured interviews and observations were used to collect data. For sampling, first, the purposeful and then theoretical methods (guided by the created categories) were used and the procedure continued until saturation of the data. The text of the handwritten notes of recorded interviews were analyzed using conventional qualitative content analysis. Results Four subclasses of “unpleasant consequences of disease”, “bitter elixir of therapy”, “an inconvenient environment” and “understanding the threat to family safety and comfort” all under the general category “enclosed in the synergistic rings of suffering” were extracted from the profound descriptions of contributors. Conclusion Mechanically ventilated patients in the intensive care unit are enclosed in the rings of suffering, so that each of these rings imposes a great deal of pain and suffering on the patient and have a synergic and intensifying effect on each other. Therefore, design and application of strategies and nursing care is essential to reduce the severity of the suffering and discomfort of these patients.
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Affiliation(s)
- Fatemeh Hajiabadi
- Instructor of Nursing, PhD Candidate, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Ph.D. of Nursing, Professor, Department of Medical- Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadat Manzari
- Ph.D. of Nursing, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Sedation versus no sedation: Are there differences in relatives' satisfaction with the Intensive Care Unit? A survey study based on data from a randomised controlled trial. Intensive Crit Care Nurs 2017; 39:59-66. [PMID: 27887881 DOI: 10.1016/j.iccn.2016.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/17/2016] [Accepted: 08/20/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Currently there is a trend towards less or no use of sedation of mechanically ventilated patients. Still, little is known about how different sedation strategies affect relatives' satisfaction with the Intensive Care Unit (ICU). AIM To explore if there was a difference in relatives' personal reactions and the degree of satisfaction with information, communication, surroundings, care and treatment in the ICU between relatives of patients who receive no sedation compared with relatives of patients receiving sedation during mechanical ventilation in the ICU. METHOD A survey study using a questionnaire with 39 questions was distributed to relatives of mechanically ventilated patients, who had been randomised to either sedation with daily wake up or no sedation. RESULTS Forty-nine questionnaires were sent out and 36 relatives answered. The response rate was 73%. We found no differences in relatives' personal reactions or in the degree of satisfaction with information, communication, care and treatment in the ICU between relatives of patients in the two groups. Relatives of patients treated with no sedation felt more bothered by disturbances in the surroundings compared with relatives of patients who were sedated (p=0.03). CONCLUSION Treating the patient during mechanical ventilation with no sedation does not affect relatives' satisfaction adversely.
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Martinho CIF, Rodrigues ITRM. Communication of mechanically ventilated patients in intensive care units. Rev Bras Ter Intensiva 2017; 28:132-40. [PMID: 27410408 PMCID: PMC4943050 DOI: 10.5935/0103-507x.20160027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/29/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. METHODS This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. RESULTS Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach's alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be "quite hard" (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable "number of hours after extubation" (p < 0.05). CONCLUSION This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was "quite hard", and these communication difficulties apparently existed regardless of the presence of other clinical and/or sociodemographic variables.
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Karlsson V, Bergbom I. ICU Professionals’ Experiences of Caring for Conscious Patients Receiving MVT. West J Nurs Res 2014; 37:360-75. [DOI: 10.1177/0193945914523143] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over the last decade, caring for patients who are conscious while receiving mechanical ventilator treatment has become common in Scandinavian intensive care units. Therefore, this study aimed to describe anesthetists’, nurses’, and nursing assistants’ experiences of caring for such patients. Nine persons were interviewed. A hermeneutic method inspired by Gadamer’s philosophy was used to interpret and analyze the interview text. Staff members found it distressing to witness and be unable to alleviate suffering, leading to ethical conflicts, feelings of powerlessness, and betrayal of the promises made to the patient. They were frustrated about their inability to understand what the patients were trying to say and often turned to colleagues for help. When caring for conscious patients, it takes time to get to know them and establish communication and a trusting relationship.
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10
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Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.medine.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Celis-Rodríguez E, Birchenall C, de la Cal M, Castorena Arellano G, Hernández A, Ceraso D, Díaz Cortés J, Dueñas Castell C, Jimenez E, Meza J, Muñoz Martínez T, Sosa García J, Pacheco Tovar C, Pálizas F, Pardo Oviedo J, Pinilla DI, Raffán-Sanabria F, Raimondi N, Righy Shinotsuka C, Suárez M, Ugarte S, Rubiano S. Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo. Med Intensiva 2013; 37:519-74. [DOI: 10.1016/j.medin.2013.04.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/16/2013] [Indexed: 01/18/2023]
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Plakas S, Taket A, Cant B, Fouka G, Vardaki Z. The meaning and importance of vigilant attendance for the relatives of intensive care unit patients. Nurs Crit Care 2013; 19:243-54. [PMID: 24131580 DOI: 10.1111/nicc.12054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore the meaning of vigilant attendance for relatives of critically ill patients in Greece. BACKGROUND A plethora of international research has identified proximity to the patient to be a major concern for relatives of critically ill patients. Greece however follows a strict visiting policy in intensive care units (ICUs) so Greek relatives spend great amounts of time just outside the ICUs. DESIGN This qualitative study adopted the social constructionist version of grounded theory. METHOD Data were collected from three ICUs in Athens through in depth interviews with 25 informants and approximately 10 h of observations outside the ICUs on 159 relatives. FINDINGS Vigilant attendance was one of the main coping mechanisms identified for relatives. Four subcategories were found to comprise vigilant attendance: (1) being as close as possible to feel relief, (2) being there to find out what is going on, (3) monitoring changes in the loved one and making own diagnosis and (4) interacting with the ICU professionals. CONCLUSION Vigilant attendance describes the way in which relatives in Greece stayed outside the ICUs. Relatives felt satisfaction from being close as the best alternative for not actually being inside the ICU and they tried to learn what was going on by alternative methods. By seeing the patients, relatives were also able to make their own diagnoses and could therefore avoid relying solely on information given to them. However, a prerequisite for successful vigilant attendance was to get on well with doctors and nurses. RECOMMENDATIONS FOR CLINICAL PRACTICE Changes in visiting policies in Greece are needed to meet the needs of relatives adequately. Recommendations for changes with minimal investment of time and funding are made.
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Affiliation(s)
- Sotirios Plakas
- S Plakas, RN, MSc, PhD, Lecturer, Nursing B' Department, School of Health and Welfare, Technological Educational Institution (TEI) of Athens, Egaleo, Greece
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14
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Communication when patients are conscious during respirator treatment—A hermeneutic observation study. Intensive Crit Care Nurs 2012; 28:197-207. [DOI: 10.1016/j.iccn.2011.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 12/12/2011] [Accepted: 12/15/2011] [Indexed: 11/22/2022]
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Blom H, Gustavsson C, Sundler AJ. Participation and support in intensive care as experienced by close relatives of patients: a phenomenological study. Intensive Crit Care Nurs 2012; 29:1-8. [PMID: 22748280 DOI: 10.1016/j.iccn.2012.04.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 04/11/2012] [Accepted: 04/21/2012] [Indexed: 11/16/2022]
Abstract
AIM The aim of this study was to explore participation and support as experienced by close relatives of patients at an intensive care unit (ICU). METHOD This study used the phenomenological approach as developed by Dahlberg et al. (2008) as a method for reflective lifeworld research. Seven close relatives of critically ill patients cared for at an ICU were interviewed. The data were analysed with a focus on meanings. RESULTS Being allowed to participate in the care of critically ill patients at an ICU is important for close relatives to the patients. Their experiences can be described as having four constituents: participation in the care of and being close to the patient; confidence in the care the patient receives; support needed for involvement in caregiving; and vulnerability. CONCLUSION Participation with and support from health-care professionals are important for the relatives' well-being and their ability to contribute to the patients' care. Health-care professionals, especially critical care nurses, need to create an atmosphere that invites relatives to participate in the care provided at an ICU.
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Affiliation(s)
- Helen Blom
- Department of Intensive Care Unit, Skaraborg Hospital, Skövde, Sweden
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Olausson S, Ekebergh M, Lindahl B. The ICU patient room: Views and meanings as experienced by the next of kin: A phenomenological hermeneutical study. Intensive Crit Care Nurs 2012; 28:176-84. [DOI: 10.1016/j.iccn.2011.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 11/30/2011] [Accepted: 12/07/2011] [Indexed: 11/15/2022]
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Broyles LM, Tate JA, Happ MB. Use of augmentative and alternative communication strategies by family members in the intensive care unit. Am J Crit Care 2012; 21:e21-32. [PMID: 22381993 PMCID: PMC3607206 DOI: 10.4037/ajcc2012752] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Little is known about communication between patients and their family members during critical illness and mechanical ventilation in the intensive care unit, including use of augmentative and alternative communication tools and strategies. OBJECTIVES To identify (1) which augmentative and alternative communication tools families use with nonspeaking intensive care patients and how they are used, and (2) what families and nurses say about communication of family members with nonspeaking intensive care patients. METHODS A qualitative secondary analysis was conducted of existing data from a clinical trial testing interventions to improve communication between nurses and intensive care patients. Narrative study data (field notes, intervention logs, nurses' interviews) from 127 critically ill adults were reviewed for evidence of family involvement with augmentative and alternative communication tools. Qualitative content analysis was applied for thematic description of family members' and nurses' accounts of patient-family communication. RESULTS Family involvement with augmentative and alternative communication tools was evident in 44% of the 93 patients who completed the parent study protocol. Spouses or significant others communicated with patients most often. Main themes describing patient-family communication included (1) families being unprepared and unaware, (2) families' perceptions of communication effectiveness, (3) nurses deferring to or guiding patient-family communication, (4) patients' communication characteristics, and (5) families' experience with and interest in augmentative and alternative communication tools. CONCLUSIONS Assessment by skilled bedside clinicians can reveal patients' communication potential and facilitate useful augmentative and alternative communication tools and strategies for patients and their families.
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Affiliation(s)
- Lauren M Broyles
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, PA, USA
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Karlsson V, Bergbom I, Forsberg A. The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic study. Intensive Crit Care Nurs 2012; 28:6-15. [DOI: 10.1016/j.iccn.2011.11.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 11/08/2011] [Accepted: 11/12/2011] [Indexed: 10/14/2022]
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Flodén A, Persson LO, Rizell M, Sanner M, Forsberg A. Attitudes to organ donation among Swedish ICU nurses. J Clin Nurs 2011; 20:3183-95. [PMID: 21564363 DOI: 10.1111/j.1365-2702.2011.03756.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To present data on Swedish ICU nurses' attitudes to brain death and organ donation and to test a questionnaire designed to explore these issues in terms of validity and reliability. BACKGROUND Previous studies have identified various barriers to organ donation. The single most important factor was the attitude of ICU staff. DESIGN A 34-item instrument was developed to explore attitudes and experiences of organ donation. METHOD The questionnaire was sent to 50% of ICU nurses in Sweden (n = 1013) and the response rate was 69% (n = 702). The expected scale dimensionality was examined both by explorative principal component analysis and confirmatory multi-trait analysis. Scale reliability was further estimated using Cronbach's alpha. Chi-squared test was used to compare proportions between ICU specialities and Pearson correlations were calculated to investigate relationships between each of the factors verified and the single items. RESULTS The main findings were that less than half of the ICU nurses trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. Twenty-five percent of the respondents indicated that mechanical ventilation was withdrawn to reduce the possible suffering of a person assumed to be clinically dead, without the issue of organ donation being raised. A total of 39% had experienced occasions when the question about organ donation was never raised with the relatives. Four factors were verified and labelled: personal attitudes to organ donation as a situation; Organisational attitudes to organ donation as a phenomenon; Environmental resources; and Personal wish to donate, which accounted for 70% of the variance. CONCLUSIONS Swedish ICU nurses reported several barriers to organ donation. An action plan including education in brain death diagnostics, interpersonal relationships and interaction with relatives as well as regular follow-up regarding donation issues in various ICU settings would be useful. RELEVANCE TO CLINICAL PRACTICE All nurses working in ICUs are obliged to participate in organ donation and are therefore included in these results.
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Affiliation(s)
- Anne Flodén
- The Unit for Organ and Tissue Donation, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Eriksson T, Bergbom I, Lindahl B. The experiences of patients and their families of visiting whilst in an intensive care unit – A hermeneutic interview study. Intensive Crit Care Nurs 2011; 27:60-6. [DOI: 10.1016/j.iccn.2011.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 12/02/2010] [Accepted: 01/07/2011] [Indexed: 11/30/2022]
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Randen I, Bjørk IT. Sedation practice in three Norwegian ICUs: a survey of intensive care nurses' perceptions of personal and unit practice. Intensive Crit Care Nurs 2010; 26:270-7. [PMID: 20709554 DOI: 10.1016/j.iccn.2010.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 06/28/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe intensive care nurses' perceptions of unit and personal sedation practice in the context of nursing and medical treatment of adult intensive care patients sedated and ventilated for more than 24 hours. METHODS Self-administered questionnaire. SETTING Three general ICUs in three university hospitals in Norway. RESULTS Eighty-six questionnaires were returned (response rate 47%). Continuous infusions of fentanyl and midazolam were perceived as most common and nurses often gave both analgesics and sedatives prior to care. Daily interruption of sedation or analgesia-based sedation was not perceived as practice in the units. MAAS was most commonly used, whilst protocols or objective scoring systems were not. Documentation of sedation levels was fairly routine, whereas documentation of patient needs was not perceived as important. Collaboration with physicians was viewed as most important, whilst no significance was assigned to collaboration with relatives. CONCLUSION The study shows that a focus on analgesia-based sedation and continual control of the sedation level should be considered in order to decrease the risk of oversedation. Inclusion of relatives' opinions, increased collaboration between nurses and physicians, and implementation of sedation tools, may contribute to even better patient outcome and should be focus in further studies.
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Affiliation(s)
- Irene Randen
- Department of Intensive Care Nursing, Lovisenberg Deaconal College, Oslo, Norway.
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