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Lin FF, Murphy N, Martinez A, Marshall AP. Facilitators and barriers to evidence-based practice in central venous access device insertion and management in an intensive care unit: A qualitative study. Intensive Crit Care Nurs 2024; 80:103553. [PMID: 37783178 DOI: 10.1016/j.iccn.2023.103553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/27/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Research evidence and clinical practice guidelines exist on preventing central line-associated bloodstream infections. However, there is limited knowledge about the barriers and facilitators to evidence-based central venous access device care. AIM The aim of this study was to investigate the facilitators and barriers to evidence-based central venous access device care in the adult intensive care setting. METHOD This exploratory qualitative study involved focus groups and interviews with registered nurses and physicians involved in central venous access device insertion and management in a tertiary Australian intensive care unit. Purposive sampling was used to recruit staff (n = 26) with varying years of clinical experience and clinical positions. Six focus groups and three individual interviews were conducted. Interviews were audio recorded, transcribed verbatim and analysed using content analysis. RESULTS Three overarching categories emerged: work structures to support optimal performance; processes to optimise quality of care, and factors influencing staff members' behaviour. Perceived facilitators to optimal central venous access device care included explicit language use in procedure documents, work-system integrated strategies, research evidence dissemination, audit, and feedback. However, there was a lack of consistency in practices such as audit, feedback, and patient participation. CONCLUSION To bring about effective improvement in central venous access device care, future interventions should be tailored to address identified barriers, including integrating audit and feedback into clinicians' work processes. Additionally, future research is needed to explore the role of patients and their families in central venous access device care. IMPLICATIONS FOR CLINICAL PRACTICE When developing practice policies or procedure manuals, it is important to use explicit language to ensure clear communication of evidence-based recommendations to clinicians. Strategies integrated into work processes can enhance adherence to evidence-based practice. Large departments with limited educators should explore innovative methods like online education to ensure optimal central venous access device care.
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Affiliation(s)
- Frances Fengzhi Lin
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, South Australia, Australia; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Health, University of the Sunshine Coast, Queensland, Australia; Sunshine Coast Health Institute, Queensland, Australia.
| | - Niki Murphy
- Intensive Care Unit, Gold Coast University Hospital, Queensland Health, Queensland, Australia
| | - Angelly Martinez
- Intensive Care Unit, Gold Coast University Hospital, Queensland Health, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Gold Coast Hospital and Health Service, Queensland, Australia
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Marshall AP, Van Scoy LJ, Chaboyer W, Chew M, Davidson J, Day AG, Martinez A, Patel J, Roberts S, Skrobik Y, Taylor B, Tobiano G, Heyland DK. A randomised controlled trial of a nutrition and a decision support intervention to enable partnerships with families of critically ill patients. J Clin Nurs 2023; 32:6723-6742. [PMID: 37161555 DOI: 10.1111/jocn.16752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/14/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
AIMS AND OBJECTIVES The aim of the study was to investigate the effect of supporting family members to partner with health professionals on nutrition intakes and decision-making and to evaluate intervention and study feasibility. BACKGROUND Family partnerships can improve outcomes for critically ill patients and family members. Interventions that support families to engage with health professionals require evaluation. DESIGN A multi-centre, randomised, parallel group superiority Phase II randomised controlled trial. METHODS In nine intensive care units (ICUs) across three countries, critically ill patients ≥60 years, or those 55-59 years with advanced chronic diseases and expected ICU length of stay >72 h and their family member were enrolled between 9 May 2017 and 31 March 2020. Participants were randomised (1:1:1) to either a decision support or nutrition optimisation family-centred intervention, or usual care. Primary outcomes included protein and energy intake during ICU and hospital stay (nutrition intervention) and family satisfaction (decision support). Study feasibility was assessed as a composite of consent rate, intervention adherence, contamination and physician awareness of intervention assignment. RESULTS We randomised 135 patients/family members (consent rate 51.7%). The average rate of randomisation was 0.5 (0.13-1.53) per month. Unavailability (staff/family) was the major contributor to families not being approached for consent. Declined consent was attributed to families feeling overwhelmed (58/126, 46%). Pandemic visitor restrictions contributed to early study cessation. Intervention adherence for the decision support intervention was 76.9%-100.0% and for the nutrition intervention was 44.8%-100.0%. Nutritional adequacy, decisional conflict, satisfaction with decision-making and overall family satisfaction with ICU were similar for all groups. CONCLUSIONS Active partnerships between family members and health professionals are important but can be challenging to achieve in critical care contexts. We were unable to demonstrate the efficacy of either intervention. Feasibility outcomes suggest further refinement of interventions and study protocol may be warranted. RELEVANCE TO CLINICAL PRACTICE Interventions to promote family partnerships in critical illness are needed but require a greater understanding of the extent to which families want and are able to engage and the activities in which they have most impact. REPORTING METHOD This study has been reported following the Consolidated Standards of Reporting Trials (CONSORT) and the Template for Intervention Description and Replication (TIDieR) guidelines. PATIENT OR PUBLIC CONTRIBUTION Patients and caregivers were engaged in and contributed to the development and subsequent iterations of the two family-centred interventions use in this study. CLINICAL TRIAL REGISTRATION NUMBER Trial registration. CLINICALTRIALS gov, ID: NCT02920086. Registered on 30 September 2016. First patient enrolled on 9 May 2017 https://clinicaltrials.gov/ct2/results?cond=&term=NCT02920086&cntry=&state=&city=&dist=.
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Affiliation(s)
- Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Intensive Care Unit, Gold Coast Health, Southport, Queensland, Australia
| | - Lauren J Van Scoy
- Department of Medicine, Humanities, and Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Mary Chew
- Phoenix VA Healthcare System, Phoenix, Arizona, USA
| | - Judy Davidson
- San Diego Health, University of California, San Diego, California, USA
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Angelly Martinez
- Intensive Care Unit, Gold Coast Health, Southport, Queensland, Australia
| | - Jayshil Patel
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shelley Roberts
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Gold Coast Health, Southport, Queensland, Australia
| | - Yoanna Skrobik
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Beth Taylor
- Barnes Jewish Hospital, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Georgia Tobiano
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Gold Coast Health, Southport, Queensland, Australia
| | - Daren K Heyland
- Department of Critical Care Medicine, Queens's University, Kingston, Ontario, Canada
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Mukpradab S, Cussen J, Ranse K, Songwathana P, Marshall AP. Healthcare professionals perspectives on feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients: A descriptive qualitative study. J Clin Nurs 2023; 32:6574-6584. [PMID: 36924051 DOI: 10.1111/jocn.16685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023]
Abstract
AIMS To explore healthcare professionals' perceptions of the feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients. BACKGROUND Early mobilisation is beneficial to minimise intensive care unit acquired-weakness in critically ill patients and family engagement can help with meeting early mobilisation goals, but it is not widely practiced. Understanding healthcare professionals' perceptions of feasibility and acceptability of family engagement in early mobilisation of adult critically ill patients is required to inform future implementation strategies to promote early mobilisation. DESIGN A descriptive qualitative study. METHODS Face-to-face, individual, semi-structured interviews were conducted between August 2021 and March 2022 with healthcare professionals working in two intensive care units in Australia. The interviews were analysed using the inductive content analysis, and descriptive statistics were used to summarise participant characteristics. The COREQ checklist was followed when reporting this study. RESULTS Eleven ICU nurses, five physiotherapists and four physicians participated in the interviews. Three main categories were identified: (i) healthcare professionals' readiness, (ii) mediators of engagement and (iii) foundations for successful implementation. Most participants demonstrated a positive attitude towards an implementation of family engagement in early mobilisation for adult critically ill patients; however, capability and capacity of healthcare professionals, family members' willingness, availability and readiness and the care context were considered factors that could influence the successful implementation. CONCLUSION From the perspectives of healthcare professionals, family engagement in early mobilisation is feasible and acceptable to enact but implementation is influenced by contextual factors including, healthcare professionals' capability and capacity and family members' willingness, availability and readiness. Collaborative teamwork and preparing family members and healthcare professionals are needed to support this practice. RELEVANCE TO CLINICAL PRACTICE The findings provide important information to further identify potential strategies of family engagement in early mobilisation and to help and mitigate factors that impede implementation.
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Affiliation(s)
- Sasithorn Mukpradab
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Julie Cussen
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University Parklands Drive, Southport, Queensland, Australia
| | | | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University Parklands Drive, Southport, Queensland, Australia
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Moisey LL, Merriweather JL, Drover JW. The role of nutrition rehabilitation in the recovery of survivors of critical illness: underrecognized and underappreciated. Crit Care 2022; 26:270. [PMID: 36076215 PMCID: PMC9461151 DOI: 10.1186/s13054-022-04143-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractMany survivors of critical illness face significant physical and psychological disability following discharge from the intensive care unit (ICU). They are often malnourished, a condition associated with poor outcomes, and nutrition remains problematic particularly in the early phases of ICU recovery. Yet nutrition rehabilitation, the process of restoring or optimizing nutritional status following illness, is seldom prioritized, possibly because it is an underrecognized and underappreciated area in critical care rehabilitation and research. To date, 16 original studies have been published where one of the objectives includes measurement of indices relating to nutritional status (e.g., nutrition intake or factors impacting nutrition intake) in ICU survivors. The primary aim of this narrative review is to provide a comprehensive summary of key themes arising from these studies which form the basis of our current understanding of nutritional recovery and rehabilitation in ICU survivors. ICU survivors face a multitude of barriers in achieving optimal nutrition that are of physiological (e.g., poor appetite and early satiety), functional (e.g., dysphagia, reduced ability to feed independently), and psychological (e.g., low mood, body dysmorphia) origins. Organizational-related barriers such as inappropriate feeding times and meal interruptions frequently impact an ICU survivor’s ability to eat. Healthcare providers working on wards frequently lack knowledge of the specific needs of recovering critically ill patients which can negatively impact post-ICU nutrition care. Unsurprisingly, nutrition intake is largely inadequate following ICU discharge, with the largest deficits occurring in those who have had enteral nutrition prematurely discontinued and rely on an oral diet as their only source of nutrition. With consideration to themes arising from this review, pragmatic strategies to improve nutrition rehabilitation are explored and directions for future research in the field of post-ICU nutrition recovery and rehabilitation are discussed. Given the interplay between nutrition and physical and psychological health, it is imperative that enhancing the nutritional status of an ICU survivor is considered when developing multidisciplinary rehabilitation strategies. It must also be recognized that dietitians are experts in the field of nutrition and should be included in stakeholder meetings that aim to enhance ICU rehabilitation strategies and improve outcomes for survivors of critical illness.
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How do elderly people with malnutrition and their families perceive collaborative practice in primary care? A phenomenological study. Br J Nutr 2022; 129:1786-1792. [PMID: 35790213 DOI: 10.1017/s0007114522002045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
As a frequent and serious problem in elderly people, malnutrition is a complex health issue. It requires comprehensive care through interprofessional collaborative practice (IPCP) engaging five health professionals in primary care consisting of a physician, dentist, nurse, dietitian and pharmacist. In Indonesia, the usual care involves monthly health screening in community programmes named Posyandu. The current study aimed to explore perceptions of elderly people with malnutrition and their families' experiences with interprofessional teams compared with usual care in primary care. This qualitative study used the phenomenological approach based on Creswell. Interviews were conducted with fourteen elderly people and their families in the intervention group and fourteen elderly people with their families in the control group. Data were analysed using the four steps of descriptive qualitative analysis described by Giorgi, including comparing the experiences of both groups. Elderly people with malnutrition in the intervention group had more valued experiences regarding two-way communication with the IPCP team and felt it involved more comprehensive care for malnutrition management. Participants in the control group experienced communication between the health care providers and elderly people; however, it was not clear enough. There were overlapping roles among health care providers in the usual care. However, both groups shared the experience that family members are partners in nutritional management. Elderly people and their families in the intervention group have more valuable experiences related to two-way communication and comprehensive care. Family as partners was experienced in both the intervention and control groups.
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Mohialdeen Gubari MI, Hosseinzadeh-Attar MJ, Hosseini M, Mohialdeen FA, Othman H, Hama-ghareeb KA, Norouzy A. Nutritional Status in Intensive Care Unit: A Meta-Analysis and Systematic Review. Galen Med J 2021; 9:e1678. [PMID: 34466565 PMCID: PMC8344180 DOI: 10.31661/gmj.v9i0.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/12/2019] [Accepted: 09/05/2019] [Indexed: 11/16/2022] Open
Abstract
It is important to consider the nutritional status of patients in the intensive care unit (ICU) since it is a key element in the ability to overcome and survive critical illnesses and clinical outcomes. The aim of the present study was to provide a meta-analysis and systematic overview in determining the nutritional status of patients in ICU by examining other studies. All studies published during 2015-2019 on nutritional status in ICU were retrieved from Medline (via PubMed), Embase, Scopus, and Web of Science databases. Finally, 23 articles were included in the meta-analysis. Results obtained from these studies showed that the nutritional status of patients in ICU was inappropriate (the pooled proportion of malnutrition was 0.51 in the type of study stratified), in which many patients in this unit had different degrees of malnutrition (moderate-mild malnourished and severe malnutrition is 0.46 and 20%, respectively). According to the results of this study, the nutritional status of patients in ICU was unsatisfactory; hence, it is necessary to consider the nutritional status along with other therapeutic measures at the beginning of the patient's admission.
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Affiliation(s)
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
- Centre of Research Excellence in Translating, Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fadhil Ahmed Mohialdeen
- Community Health Department, Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq
| | - Haval Othman
- General Shar Teaching Hospital, ICU Unit, Sulaimani, Iraq
| | | | - Abdolreza Norouzy
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
- Correspondence to: Dr. Abdolreza Norouzy, Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran Telephone Number: 09153145073 Email Address:
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Malnutrition, Family Support, and Possible Sarcopenia in Patients Undergoing Transcatheter Aortic Valve Implantation. J Cardiovasc Nurs 2021; 36:565-572. [PMID: 34016837 PMCID: PMC8542073 DOI: 10.1097/jcn.0000000000000819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Possible sarcopenia, aortic valve stenosis, and malnutrition are important issues that afflict older adults. Objective The aims of this study were to compare the differences in nutritional status and family support in older adults with possible sarcopenia and those without sarcopenia after undergoing transcatheter aortic valve implantation (TAVI) and to identify the predictors of malnutrition and demonstrate changes in heart function over time after undergoing TAVI. Methods A case-control design was conducted. Possible sarcopenia was identified by measuring calf circumference, grip strength, and gait speed. The Mini Nutritional Assessment-Short Form and numerical family support rating scale were used to collect data. Left ventricular ejection fraction and New York Heart Association (NYHA) functional class were assessed at 5 time points to evaluate heart function. Results Eighty-one participants were categorized into those without sarcopenia (34) and those with possible sarcopenia (47). Logistic linear regression showed albumin and possible sarcopenia to be predictors of malnutrition (odds ratio, 5.5; 95% confidence interval, 1.02–30.19). Family support was associated with nutrition status (P = .019). For patient heart function, the results of NYHA functional class and left ventricular ejection fraction improved over time after TAVI. The improvement in NYHA functional class at T2 was significantly different between the 2 groups compared with that at T0. Conclusions The nutrition level was higher among participants without sarcopenia than those with possible sarcopenia. Approximately 90% of the participants indicated that they had high family support. Demographic factors and albumin levels could be used to evaluate risk of malnutrition. Patients without possible sarcopenia showed greater improvement in NYHA class.
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Nienow MK, Susterich CE, Peterson SJ. Prioritizing nutrition during recovery from critical illness. Curr Opin Clin Nutr Metab Care 2021; 24:199-205. [PMID: 33394715 DOI: 10.1097/mco.0000000000000728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Patients admitted to the intensive care unit (ICU) often experience a significant decline in nutritional status due to a combination of the physiologic response to critical illness and insufficient calorie intake. The majority of research related to nutrition interventions for this population focuses on nutrition support during the acute phase. Minimal attention is given to the nutritional status of ICU patients during the recovery phase. This review will describe calorie intake when ICU care ends, provide an overview of barriers that limit intake, and possible interventions to improve nutritional status. RECENT FINDINGS Current evidence suggests patients are consuming < 60% of calorie requirements after extubation and ICU discharge. This inadequate calorie intake may exacerbate weight loss and muscle and fat wasting. Physiologic, physical, and cognitive manifestations of critical illness can lead to multiple issues that cause poor intake. Possible interventions to improve calorie intake include a patient-centered approach that utilizes oral nutrition supplements and enteral nutrition. SUMMARY Consuming adequate caloric intake in the recovery phase of critical illness is essential for rehabilitation. A systematic, patient centered approach that includes close monitoring of calorie and protein and timely interventions may be the best method to improve overall intake.
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Affiliation(s)
- Morgan K Nienow
- Department of Food and Nutrition, Rush University Medical Center
| | | | - Sarah J Peterson
- Department of Clinical Nutrition, College of Health Sciences, 600 S Paulina St, Office 737B, Chicago, Illinois, USA
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Family participation in the care of older adult patients admitted to the intensive care unit: A scoping review. Geriatr Nurs 2020; 41:474-484. [PMID: 32059826 DOI: 10.1016/j.gerinurse.2020.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 12/28/2022]
Abstract
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.
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Marshall AP, Takefala T, Williams LT, Spencer A, Grealish L, Roberts S. Health practitioner practices and their influence on nutritional intake of hospitalised patients. Int J Nurs Sci 2019; 6:162-168. [PMID: 31406886 PMCID: PMC6608649 DOI: 10.1016/j.ijnss.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/20/2019] [Accepted: 03/06/2019] [Indexed: 11/05/2022] Open
Abstract
Objectives In the hospital setting, poor dietary intake interacts with disease and represents a major and modifiable cause of malnutrition. Understanding barriers to adequate dietary intake is an important strategy to guide the development of interventions to improve nutrition intake. The aim of this study reported in this paper was to explore patient, family and health care professionals' perceptions of barriers to and enablers of adequate nutrition care and dietary intake of medical inpatients. Methods An exploratory qualitative study design incorporating group and individual interviews of patients (n = 14), their family members (n = 4), and health care professionals (n = 18) was undertaken. Participants were recruited pragmatically, using a mix of convenience and purposive sampling. A theoretically informed, semi-structured interview schedule was based on observations of practice and the Theoretical Domains Framework. Interviews were audio-recorded, transcribed verbatim and analysed inductively using a general inductive approach. Results Three key themes emerged from analysing participant interviews. Siloed approaches to nutrition care reflected the diverse range of health care professionals responsible for nutrition care but who often worked in isolation from their colleagues. Competing work priorities for nurses reflected the challenge in prioritise nutrition care which was often constrained because of other care needs or work-related pressures. Helping patients to eat highlighted that nurses were often the only health care professional who would provide assistance to patients at mealtimes and lack of available staff could negatively influence patients' nutrition intakes. Conclusions We have identified many complex and interrelated barriers which preclude adequate dietary intake in acute medical patients. These predominantly reflect issues inherent in the hospital culture and environment. Multi-faceted and sustainable interventions that support a facilitating nutrition culture and multidisciplinary collaboration, inclusive of patients and families, are needed to address these underlying barriers.
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Affiliation(s)
- Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, 1 Hospital Blvd, QLD, Australia
| | - Tahnie Takefala
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia
| | - Alan Spencer
- Department of Nutrition and Dietetics, Gold Coast Health, 1 Hospital Blvd, QLD, Australia
| | - Laurie Grealish
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, 1 Hospital Blvd, QLD, Australia
| | - Shelley Roberts
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, QLD, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia.,Department of Nutrition and Dietetics, Gold Coast Health, 1 Hospital Blvd, QLD, Australia
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And the award goes to..... Aust Crit Care 2019. [DOI: 10.1016/s1036-7314(19)30071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jarden RJ, Sutton-Smith L, Boulton C. Oral intake evaluation in patients following critical illness: an ICU cohort study. Nurs Crit Care 2018; 23:179-185. [PMID: 29659093 DOI: 10.1111/nicc.12343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 12/18/2022]
Abstract
Timely and adequate nutrition improves health outcomes for the critically ill patient. Despite clinical guidelines recommending early oral nutrition, survivors of critical illness experience significant nutritional deficits. This cohort study evaluates the oral nutrition intake in intensive care unit (ICU) patients who have experienced recent critical illness. The oral nutrition intake of a convenience sample of ICU patients post-critical illness was observed during a 1-month period. Data pertaining to both the amount of oral nutrition intake and factors impacting optimal oral nutrition intake were collected and analysed. Inadequate oral intake was identified in 62% of the 79 patients assessed (n = 49). This was noted early in the ICU stay, around day 1-2, for most of the patients. A significant proportion (25%) of patients remained in the hospital with poor oral intake that persisted beyond ICU day 5. Unsurprisingly, these were the patients who had longer ICU stays. Critical illness weakness was a factor in the assessment of poor oral intake. To conclude, patients who have experienced critical illness also experience suboptimal oral nutrition. The three key factors that were identified as impacting optimal oral nutrition were early removal of nasogastric tubes, critical illness weakness and poor appetite post-critical illness. Seven key recommendations are made based on this cohort study. These recommendations are related to patient assessment, monitoring, documentation and future guidelines. Future research opportunities are highlighted, including the investigation of strategies to improve the transition of patients' post-critical illness to oral nutrition.
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Affiliation(s)
- Rebecca J Jarden
- Department of Nursing, School of Clinical Sciences, Auckland University of Technology (AUT), Auckland, New Zealand
| | - Lynsey Sutton-Smith
- Intensive Care Unit, Intensive Care Services, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand.,Graduate School of Nursing Midwifery & Health (GSNMH), Victoria University of Wellington, Wellington, New Zealand
| | - Catherine Boulton
- Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
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Molassiotis A, Roberts S, Cheng HL, To HKF, Ko PS, Lam W, Lam YF, Abbott J, Kiefer D, Sanmugarajah J, Marshall AP. Partnering with families to promote nutrition in cancer care: feasibility and acceptability of the PIcNIC intervention. BMC Palliat Care 2018; 17:50. [PMID: 29558917 PMCID: PMC5859412 DOI: 10.1186/s12904-018-0306-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/14/2018] [Indexed: 02/07/2023] Open
Abstract
Background Malnutrition is frequent in patients with cancer, particularly those in advanced stages of the disease. The aim of the present study was to test the feasibility of a family-centred nutritional intervention, based on the Family Systems theory and past research. Methods This was a single-arm trial assessing feasibility (eligibility, recruitment and retention rates); acceptability by patients, family caregivers and health professionals; intervention fidelity, and energy/protein intake (in one site only). Two sites were involved; one each in Australia (AUS) and Hong Kong (HK), with one site delivering the intervention to oncology patients receiving curative treatments in the hospital, and the other to advanced cancer patients in the home. Results The sample included 53 patients (23 from AUS and 30 from HK), 22 caregivers (3 from AUS and 19 from HK) and 30 health professionals (20 from AUS and 10 from HK). Recruitment was difficult in the acute inpatient oncology care setting (AUS) and feasibility criteria were not met. Sufficient recruitment took place in the home care setting with advanced cancer patients in HK. Patients, family members and health professionals found the intervention helpful and acceptable, and patients and families indicated they would take part in the future in a similar study. Energy and protein intake improved from baseline to end of intervention (mean 22 kcal/kg/day to 26 and 0.9 g/kg/day to 1.0 respectively). Conclusion The new intervention is feasible in a home setting when delivered to patients with advanced cancer, acceptable to patients and families, and has the potential to improve nutritional status in patients. A large randomised trial is warranted in the future. Electronic supplementary material The online version of this article (10.1186/s12904-018-0306-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Shelley Roberts
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Cost, Australia
| | - Hui Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Henry K F To
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Po Shan Ko
- Department of Medicine, Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Wang Lam
- Dietetics Department, Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Yuk Fong Lam
- Department of Medicine, Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Jessica Abbott
- Gold Coast University Hospital, Gold Coast Health, Southport, Australia
| | - Deborah Kiefer
- Gold Coast University Hospital, Gold Coast Health, Southport, Australia
| | | | - Andrea P Marshall
- National Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Cost, Australia.,Gold Coast University Hospital, Gold Coast Health, Southport, Australia
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