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Woldring JM, Luttik ML, Paans W, Gans ROB. The added value of family-centered rounds in the hospital setting: A systematic review of systematic reviews. PLoS One 2023; 18:e0280142. [PMID: 36662899 PMCID: PMC9858825 DOI: 10.1371/journal.pone.0280142] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Family engagement in care for adult inpatients may improve shared decision making in the hospital and the competence and preparedness of informal caregivers to take over the care at home. An important strategy to involve family members in hospital care processes is to include them in (ward) rounds, also called 'family-centered rounds'(FCRs). OBJECTIVES Summarize the evidence regarding the added value of FCRs from the perspectives of patients, family, and healthcare professionals. METHODS A review protocol was registered a priori with PROSPERO (number CRD42022320915). The electronic databases PubMed, CINAHL, and PsycInfo were searched for English-written systematic reviews with a focus on FCRs. The results and methods were presented in line with the PRISMA guidelines, and the methodological quality of the included reviews was assessed using the adapted version of the AMSTAR tool. RESULTS Of the 207 initial records, four systematic reviews were identified covering a total of 67 single studies, mainly performed in critical and pediatric care. Added values of FCR were described at review level, with references to single studies. All four systematic reviews reported an improvement in satisfaction among patients, family, and healthcare professionals, whereby satisfaction is linked to improved communication and interaction, improved situational understanding, inclusion of family in the decision-making process, and improved relationships within the care situation. CONCLUSION Although only limited research has been conducted on the value of FCRs in the adult non-critical care setting, and despite the existence of a variety of outcome measures, the results available from the pediatric and acute care setting are positive. The findings of the sole study in an adult non-critical patient population are in line with these results. Further research in adult non-critical care is required to verify its effects in this setting.
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Affiliation(s)
- Josien M. Woldring
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marie Louise Luttik
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Wolter Paans
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | - Reinold O. B. Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Fernández-Martínez E, Mapango EA, Martínez-Fernández MC, Valle-Barrio V. Family-centred care of patients admitted to the intensive care unit in times of COVID-19: A systematic review. Intensive Crit Care Nurs 2022; 70:103223. [PMID: 35221143 PMCID: PMC8847099 DOI: 10.1016/j.iccn.2022.103223] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe clinical practice interventions aimed at providing Family-Centred Care in intensive care units during the COVID-19 pandemic. RESEARCH METHODOLOGY A systematic review was carried out following the PRISMA recommendations in various databases: PubMed, Cinahl, Web of Science, Scopus, and Google Scholar were consulted, as well as within the grey literature found on the web pages of official organizations related to Intensive Care Medicine and Nursing. SETTING Adult intensive care unit. RESULTS The search yielded 209 documents of which 24 were included in this review: eight qualitative studies, seven protocols and recommendations from official bodies, one mixed-method studies, five descriptive studies, one cross-sectional study, one pilot program and one literature review. A thematic analysis revealed four major themes: the use of communication systems, multidisciplinary interventions; the promotion of family engagement and family support. The results show different strategies that can be implemented in clinical practice to solve the difficulties encountered in Family-Centred Care in critical care units during the COVID-19 pandemic. CONCLUSIONS There is a great variety in the nature of the interventions developed, with the use of telecommunication systems in daily practice being the most repeated aspect. Future research should aim to assess whether the interventions implemented increase the quality of patient and family care by meeting their needs.
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Affiliation(s)
- Elena Fernández-Martínez
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, León, Spain. https://twitter.com/melenafermar
| | | | | | - Verónica Valle-Barrio
- Campus de Ponferrada, Universidad de León, León, Spain; Hospital El Bierzo, Ponferrada, León, Spain.
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Simon K, Sankara IR, Gioe C, Newcomb P. Including Family Members in Rounds to Improve Communication in Intensive Care. J Nurs Care Qual 2021; 36:25-31. [PMID: 32282508 DOI: 10.1097/ncq.0000000000000483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Family members frequently function as surrogate decision-makers in critical care settings. This role requires family to establish satisfactory communication with clinicians. LOCAL PROBLEM Posthospital patient satisfaction with communication scores were lower than desired. Investigators assumed family member satisfaction with communication could influence patient satisfaction scores. METHODS/INTERVENTIONS Including family members in multidisciplinary daily clinical rounds was implemented in a 22-bed neurointensive care unit (ICU). Family members who attended rounds were compared with those who did not. Changes in clinician time devoted to rounding were measured. RESULTS The intervention increased time devoted to clinical rounds by 4 minutes per patient on average. Rounding dose correlated positively while depression correlated negatively with family satisfaction with communication. No harm, such as family member agitation, anxiety, or complaints, was found. CONCLUSIONS Including family in rounding in the ICU appears safe and can improve family satisfaction with communication, but whether it influences patient satisfaction remains an open question.
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Affiliation(s)
- Kay Simon
- Texas Health Harris Methodist Hospital, Fort Worth (Mss Simon and Gioe); Neurocritical Care Hospitalist, Neurocritical Care Associates of Fort Worth, Texas (Dr Sankara); INOVA Health System, Alexandria, Virginia (Ms Gioe); and Texas Health Resources, Arlington (Dr Newcomb)
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Kydonaki K, Takashima M, Mitchell M. Family ward rounds in intensive care: An integrative review of the literature. Int J Nurs Stud 2020; 113:103771. [PMID: 33080477 DOI: 10.1016/j.ijnurstu.2020.103771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The involvement of family members in the ward rounds is a novel but under-researched family-centered care intervention in adult intensive care units, with limited evidence on the impact it has on patient and family-centered outcomes. OBJECTIVES This integrative review aimed to understand how family rounds are implemented in critical care and to appraise the evidence on outcomes for patients, family members, and healthcare professionals. DESIGN An integrative review methodological framework permitted the inclusion of all research designs. DATA SOURCES MEDLINE; CINAHL; PsycINFO; Cochrane Library; Web of Science Current Contents Connect; Web of Science-Core Collection; The Joanna Briggs Institute EBP Database; ProQuest Sociological Abstracts; and ProQuest Dissertation and Theses Global, Embase were systematically searched. REVIEW METHODS We reviewed studies that referred to or used as an intervention the involvement of family members in daily critical care team rounds. We included primary research in adult intensive care units regardless of patients' length of stay. We excluded patients receiving end-of-life care. We considered any outcome related to the critically ill patient and/or their family member, outcomes related to the healthcare professionals, and outcomes related to clinical and/or nursing treatment. The Mixed Methods Appraisal Tool was used to appraise the quality of the studies. The review was registered in the Prospero database. RESULTS From the 541 articles initially retrieved, 15 studies met the inclusion criteria and were included in the review. Studies originated from the United States of America and Canada since 2003, and a variety of designs were used. Four before and after studies and a non-randomized experimental study explored the impact of structured family rounds on family and staff satisfaction, showing limited improvement in satisfaction. Six cross-sectional survey studies explored family members' and clinicians' perceptions and demonstrated a positive attitude towards family-centered rounds, but some concerns were raised from the nursing staff. Three qualitative studies and a mixed-methods study identified structural and cultural factors influencing healthcare professionals' and families' acceptance of family rounds. Most studies were of poor to moderate quality, with limited confidence in the outcomes reported. CONCLUSIONS Most studies reported improved family satisfaction as the main outcome. Future research should focus on longitudinal patient and family-centered outcomes, including mental health outcomes, and on qualitative data to understand the processes, barriers, and facilitators to implement family-centered rounds in intensive care units.
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Affiliation(s)
- Kalliopi Kydonaki
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, 9 Sighthill Court, EH11 4BN Edinburgh, UK.
| | - Mari Takashima
- School of Medicine, Centre for Applied Health Economics, Griffith University, Nathan campus, N16 -1.10K, QLD 4111, Australia.
| | - Marion Mitchell
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Address N48 2.14, Nathan Campus, 170 Kessels Road, Nathan, QLD 4111, Australia.
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Wang H, Poehler JL, Ziegler JL, Weiler CC, Khan SA. Patient Care Rounds in the Intensive Care Unit During COVID-19. Jt Comm J Qual Patient Saf 2020; 46:600-601. [PMID: 32768306 PMCID: PMC7334133 DOI: 10.1016/j.jcjq.2020.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/17/2022]
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Weber U, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Hamza M, White J, Coppola A, Akgün KM, Greer DM, Marcolini EG, Gilmore EJ, Petersen NH, Timario N, Poskus K, Sheth KN, Hwang DY. Dedicated Afternoon Rounds for ICU Patients' Families and Family Satisfaction With Care. Crit Care Med 2019; 46:602-611. [PMID: 29300237 DOI: 10.1097/ccm.0000000000002963] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It was hypothesized that adding dedicated afternoon rounds for patients' families to supplement standard family support would improve overall family satisfaction with care in a neuroscience ICU. DESIGN Pre- and postimplementation (pre-I and post-I) design. SETTING Single academic neuroscience ICU. PATIENTS Patients in the neuroscience ICU admitted for longer than 72 hours or made comfort measures only at any point during neuroscience ICU admission. INTERVENTION The on-service attending intensivist and a neuroscience ICU nursing leader made bedside visits to families to address concerns during regularly scheduled, advertised times two afternoons each week. MEASUREMENTS AND MAIN RESULTS One family member per patient during the pre-I and post-I periods was recruited to complete the Family Satisfaction in the ICU 24 instrument. Post-I respondents indicated whether they had participated in the afternoon rounds. For primary outcome, the mean pre-I and post-I composite Family Satisfaction in the ICU 24 scores (on a 100-point scale) were compared. A total of 146 pre-I (March 2013 to October 2014; capture rate, 51.6%) and 141 post-I surveys (October 2014 to December 2015; 47.2%) were collected. There was no difference in mean Family Satisfaction in the ICU 24 score between groups (pre-I, 89.2 ± 11.2; post-I, 87.4 ± 14.2; p = 0.6). In a secondary analysis, there was also no difference in mean Family Satisfaction in the ICU 24 score between the pre-I respondents and the 39.0% of post-I respondents who participated in family rounds. The mean Family Satisfaction in the ICU 24 score of the post-I respondents who reported no participation trended lower than the mean pre-I score, with fewer respondents in this group reporting complete satisfaction with emotional support (75% vs. 54%; p = 0.002), coordination of care (82% vs. 68%; p = 0.03), and frequency of communication by physicians (60% vs. 43%; p = 0.03). CONCLUSIONS Dedicated afternoon rounds for families twice a week may not necessarily improve an ICU's overall family satisfaction. Increased dissatisfaction among families who do not or cannot participate is possible.
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Affiliation(s)
- Urs Weber
- Yale School of Medicine, New Haven, CT
| | | | | | | | | | | | | | | | | | | | - Kathleen M Akgün
- Department of Internal Medicine, Pulmonary, Critical Care and Sleep Medicine Section, VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, CT
| | - David M Greer
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Evie G Marcolini
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Emily J Gilmore
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | - Nils H Petersen
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | | | | | - Kevin N Sheth
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | - David Y Hwang
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
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Mitchell M, Dwan T, Takashima M, Beard K, Birgan S, Wetzig K, Tonge A. The needs of families of trauma intensive care patients: A mixed methods study. Intensive Crit Care Nurs 2019; 50:11-20. [DOI: 10.1016/j.iccn.2018.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
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An Integrated Framework for Effective and Efficient Communication with Families in the Adult Intensive Care Unit. Ann Am Thorac Soc 2018; 14:1015-1020. [PMID: 28282227 DOI: 10.1513/annalsats.201612-965oi] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The increased focus on patient and family-centered care in adult intensive care units (ICUs) has generated multiple platforms for clinician-family communication beyond traditional interdisciplinary family meetings (family meetings)-including family-centered rounds, bedside or telephone updates, and electronic family portals. Some clinicians and administrators are now using these platforms instead of conducting family meetings. For example, some institutions are moving toward using family-centered rounds as the main platform for clinician-family communication, and some physicians rely on brief daily updates to the family at the bedside or by phone, in lieu of family meetings. We argue that although each of these platforms is useful in some circumstances, there remains an important role for family meetings. We outline five goals of clinician-family communication-establishing trust, providing emotional support, conveying clinical information, understanding the patient as a person, and facilitating careful decision making-and we examine the extent to which various communication platforms are likely to achieve the goals. We argue that because no single platform can achieve all communication goals, an integrated strategy is needed. We present a model that integrates multiple communication platforms to effectively and efficiently support families across the arc of an ICU stay. Our framework employs bedside/telephone conversations and family-centered rounds throughout the admission to address high informational needs, along with well-timed family meetings that attend to families' emotions as well as patients' values and goals. This flexible model uses various communication platforms to achieve consistent, efficient communication throughout the ICU stay.
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Coombs M, Puntillo KA, Franck LS, Scruth EA, Harvey MA, Swoboda SM, Davidson JE. Implementing the SCCM Family-Centered Care Guidelines in Critical Care Nursing Practice. AACN Adv Crit Care 2018; 28:138-147. [PMID: 28592473 DOI: 10.4037/aacnacc2017766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
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.
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Affiliation(s)
- Maureen Coombs
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Kathleen A Puntillo
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Linda S Franck
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Elizabeth A Scruth
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Maurene A Harvey
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Sandra M Swoboda
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Judy E Davidson
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
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Mangram A. Innovations in geriatric trauma and resident research education: bridging the gap. Am J Surg 2013; 206:834-9. [PMID: 24296094 DOI: 10.1016/j.amjsurg.2013.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/02/2013] [Accepted: 08/02/2013] [Indexed: 11/25/2022]
Abstract
The recent history of changes in the geriatric population in the US, the unique vulnerability to different mechanisms of trauma and the need for innovative management strategies to address them are discussed using the Geriatric "G-60" service as an illustration. The issue is not whether geriatric trauma "G-60" is coming; G-60 is here. A short detour into my own research experience is presented not as prescription but guidance for the development of futures cadres of surgeons. Resident research is not a luxury but key to transforming knowledge from benchside to bedside and back.
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Affiliation(s)
- Alicia Mangram
- Department of Trauma and Acute Care Surgery, John C. Lincoln North Mountain Hospital, 250 E Dunlap Avenue, Phoenix, AZ 85020, USA.
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12
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The intensive care unit family meeting: making it happen. J Crit Care 2009; 24:629.e1-12. [PMID: 19327312 DOI: 10.1016/j.jcrc.2008.10.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 10/08/2008] [Indexed: 11/22/2022]
Abstract
The intensive care unit (ICU) family meeting is an important forum for discussion about the patient's condition, prognosis, and care preferences; for listening to the family's concerns; and for decision making about appropriate goals of treatment. For patients, families, clinicians, and health care systems, the benefits of early and effective communication through these meetings have been clearly established. Yet, evidence suggests that family meetings still fail to occur in a timely way for most patients in ICUs. In this article, we address the "quality gap" between knowledge and practice with respect to regular implementation of family meetings. We first examine factors that may serve as barriers to family meetings. We then share practical strategies that may be helpful in overcoming some of these barriers. Finally, we describe performance improvement initiatives by ICUs in different parts of the country that have achieved striking successes in making family meetings happen.
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Abstract
PURPOSE OF REVIEW An appreciation of a family's difficult experience in dealing with their critically ill loved ones has created the concept of 'family-centered care'. The purpose of this paper is to review the literature on the needs of the family during their intensive care unit experience. RECENT FINDINGS Families consistently highlight three major issues that they deem could be improved from their perspective. Increased information about their loved ones, proximity to the patient and a more flexible visiting policy stand out as relevant issues to families. SUMMARY Medical staff and administrators should recognize that families of critically ill patients have particular needs that help them cope with having their loved ones in an intensive care unit. Simple changes in philosophy and policy would greatly decrease the anxiety these families experience.
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Affiliation(s)
- George F Alvarez
- University of Calgary, Rockyview General Hospital, Calgary Health Region, Calgary, Alberta, Canada.
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Sisterhen LL, Blaszak RT, Woods MB, Smith CE. Defining family-centered rounds. TEACHING AND LEARNING IN MEDICINE 2007; 19:319-22. [PMID: 17594229 DOI: 10.1080/10401330701366812] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Physicians are required to provide safe, effective, and high-quality care that is patient-centered. Continuing to meet the educational needs of residents and medical students in the setting of patient-centered care will require developing new models for hospital "work rounds." Family-centered rounds is a model of communicating and learning between the patient, family, medical professionals, and students on an academic, inpatient ward setting. Unfortunately, in the medical literature, there is no consensus on the definition of family-centered rounds. SUMMARY Despite the increased utilization of hospitalists and the recognition that bedside teaching has many benefits, bedside rounds are underutilized. In this article, we present a description of family-centered rounds that is supported by a review of the literature on bedside teaching, family-centered care, and interdisciplinary care. The key difference between family-centered rounds and traditional bedside teaching is the active participation of the patient and family in the discussion. Interdisciplinary care implies that professionals from a variety of disciplines work collaboratively to develop a unified care plan. Family-centered rounding provides an interface between families and medical professionals that allows education of medical students and residents as well as the development of a unified care plan. CONCLUSIONS Family-centered rounds hold potential to create a patient-centered environment, enhance medical education, and improve patient outcomes. The model is a planned, purposeful interaction that requires the permission of patients and families as well as the cooperation of physicians, nurses, and ancillary staff.
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Affiliation(s)
- Laura L Sisterhen
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA.
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