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Peruma M, Emmamally W, Mooi M, Okafor UB. A cross-sectional study on patient-centered care in a selected hospital in eThekwini district, KwaZulu-Natal, South Africa. Health SA 2025; 30:2913. [PMID: 40183025 PMCID: PMC11966697 DOI: 10.4102/hsag.v30i0.2913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 02/12/2025] [Indexed: 04/05/2025] Open
Abstract
Background Clinical healthcare reform demands high-quality patient care, especially in emergencies. Patient-centred care (PCC) prioritises therapy based on health, characteristics, and needs. Aim This study examines critical care nurses' views on PCC in a hospital in eThekwini, KwaZulu-Natal. Setting The study was conducted at a selected tertiary care facility in eThekwini district, KwaZulu-Natal, South Africa. Methods This cross-sectional study examined 119 conveniently selected critical care nurses from five units treating critically ill adult patients in a central tertiary care hospital in eThekwini district, KwaZulu-Natal, South Africa. Personified patient care was measured using the Individualised Care Scale (ICS). Results The mean values for nurse-supported customised care ranged from 4.27 ± 0.66 to 4.44 ± 0.61. Fear and anxiety during patient discussions have the highest mean score (4.44 ± 0.61). The mean values for four personal life statements were 4.22 ± 0.72 to 4.29 ± 0.65. Hospitalisation experience was surveyed by 90.8% of people, with a mean score of 4.29 ± 0.61. Patients' desire to understand their illness was surveyed by nurses (91.60%) with a mean score of 4.39 ± 6.39. The majority (94.9%) of nurses encouraged patients to express care preferences, whereas 85.8% were inquired about their preferred bathing time. The majority (59.70%) scored average, while 38.70% high. Conclusion Patient-centred care support was average among critical care nurses. Training and education in critical care should emphasise PCC. To strengthen PCC in clinical practice, execute PCC activities regularly. Contribution The study revealed PCC actions and indicated critical care nurses' average support.
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Affiliation(s)
- Marcel Peruma
- Department of Nursing Science, College of Science, University of KwaZulu-Natal, Westville, South Africa
| | - Waheedha Emmamally
- Department of Nursing Science, College of Science, University of KwaZulu-Natal, Westville, South Africa
| | - Mildred Mooi
- Department of Nursing Science, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Uchenna B Okafor
- Department of Nursing Science, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
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Park EJ, Seong J, Shin JW, Tate JA, Choi J. Communication intervention for families in adult intensive care units during COVID-19 pandemic: A systematic review. Heart Lung 2024; 68:175-190. [PMID: 39024905 DOI: 10.1016/j.hrtlng.2024.07.004] [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: 01/03/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Restrictions on ICU family visitation during COVID-19 pandemic posed communication challenges for families, patients, and healthcare teams. Diverse approaches were used to overcome communication barriers. As ICUs begin to reinstate family visitation, it is timely to review the lessons learned from these interventions during the pandemic. OBJECTIVES To identify and evaluate content and qualities of the studies that describe communication interventions for families of adult ICU patients during the COVID-19 pandemic. METHODS Following the PRISMA guidelines, we searched PubMed, Embase, CINAHL, and Web of Science for studies that (1) involved communication intervention for families in adult ICU settings, (2) were published between January 2020 and September 2022, and (3) were published in English. We excluded studies that were not from peer-reviewed journal articles or in English. RESULTS Of 2,628 articles initially identified, we reviewed the 23 selected studies (20 non-experimental and 3 experimental studies). Most of the studies were published in 2022 (n = 14, 60.9 %) and conducted in Europe (n = 13, 56.5 %). Various communication methods (e.g., video calls, telephone, applications) were used to provide information, emotional support, and virtual access to patients and their families. Video calls were the most frequently used intervention. Many interventions included healthcare teams providing updates on the patient's condition or treatment to the family. CONCLUSIONS The COVID-19 pandemic prompted the adoption of diverse communication approaches for families in ICU settings, despite many limitations, including technical challenges. Insights gained from this experience will help expedite flexibility and diversity in designing communication interventions for ICU family members.
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Affiliation(s)
- Eun Ju Park
- Yonsei University College of Nursing, Seoul, South Korea
| | - Jooyeon Seong
- Yonsei University College of Nursing, Seoul, South Korea
| | - Ji Won Shin
- The Ohio State University, College of Nursing, Columbus, OH, USA
| | - Judith A Tate
- The Ohio State University, College of Nursing, Columbus, OH, USA
| | - JiYeon Choi
- Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, Seoul, South Korea; Yonsei University Institute for Innovation in Digital Healthcare, Seoul, South Korea.
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Joo Y, Jang Y, Park CG, Yang YL. Development and validation of a patient-centered communication scale for nurses. BMC Nurs 2024; 23:550. [PMID: 39135182 PMCID: PMC11320938 DOI: 10.1186/s12912-024-02174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Patient-centered care aims to prevent disease and promote well-being by actively involving patients in treatment and decision-making that is based on respecting the patients and their families. However, no scales have been developed to assess patient-centered care from the nurse's perspective. This study aimed to develop a scale to measure nurses' level of patient-centered communication and confirm its validity and reliability. METHODS A methodological cross-sectional study was adopted to develop and validate the Patient-Centered Communication Scale (PCCS). The items were developed through a literature review and online interviews with nurses. Content validity was assessed by experts and the content validity index was calculated. A pretest of the questionnaire was conducted with 10 clinical nurses. To evaluate the factor structure and internal consistency reliability, the PCCS was administered online to 325 nurses in South Korea. Data were analyzed using descriptive statistics, explanatory factor analysis (EFA), and confirmatory factor analysis (CFA). RESULTS The final instrument consisted of 12 items and three factors: (1) information sharing, (2) patient-as-person, and (3) therapeutic alliance. EFA revealed a distinct three-factor structure, explaining 59.0% of the total variance. CFA confirmed the adequacy of the model fit and validated the inclusion of the final items. The Cronbach's alpha values ranged from 0.60 to 0.77, indicating acceptable internal consistency. Convergent validity was evidenced by the correlation between the PCCS and a measure of interpersonal communication competence. CONCLUSIONS The 12-item PCCS showed good reliability, construct validity, and convergent validity. The scale has utility for measuring the level of patient-centered communication skills in nurses.
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Affiliation(s)
- Youngshin Joo
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Chang Gi Park
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - You Lee Yang
- College of Nursing, Eulji University, 553, Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 13135, Republic of Korea.
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Patra M, Hamiduzzaman M, McLaren H, Siddiquee NA. A Scoping Review of Changes to Patient-Doctor Communication During COVID-19. HEALTH COMMUNICATION 2024; 39:25-48. [PMID: 36522301 DOI: 10.1080/10410236.2022.2152225] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Effective communication between patients and doctors is fundamental to high-quality healthcare, patient safety, and overall satisfaction. However, the onset of COVID-19 has prompted significant shifts in communication from in-room and face-to-face interactions to virtual consults. The impact of this pandemic-related change on patient-doctor communication goals, processes, attributes, and environment remains unclear. We undertook a scoping review involving the systematic search of seven academic databases for relevant articles published up to and including June 2021. In total, 47 articles were identified that met the inclusion criteria. We applied the patient-doctor communication framework to guide our deductive thematic analysis of articles included, sorting results from reported studies and position papers into themes and sub-themes. The theme of communication goals highlighted sub-themes related to patient safety, convenience, affordability, and satisfaction; preparation included sub-themes on technology interventions, workforce training, and digital literacy; participant attributes included compassion for doctors and rebuilding trust among patients; and communication process included issues related to telemedicine or video conferencing, challenges with diminished patient privacy, and distractions in the patient's home setting. Finally, the environment theme included insights into doctors' workload, isolation, and anxiety and how changes requiring increases in virtual consults iteratively altered confidence in care provision and communication with patients. Results of the scoping review provide important insights for strengthening virtual patient-doctor interactions, including target areas for training and professional development during and beyond the current pandemic.
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Affiliation(s)
- Mahua Patra
- Department of Sociology, Maulana Azad College, University of Calcutta
| | | | - Helen McLaren
- College of Education, Psychology & Social Work, Flinders University
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Yu C, Xian Y, Jing T, Bai M, Li X, Li J, Liang H, Yu G, Zhang Z. More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients. Front Public Health 2023; 11:1148277. [PMID: 37927879 PMCID: PMC10620693 DOI: 10.3389/fpubh.2023.1148277] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Objective The objective of this study is to explore the association between patient-centered care (PCC) and inpatient healthcare outcomes, including self-reported physical and mental health status, subjective necessity of hospitalization, and physician-induced demand behaviors. Methods A cross-sectional survey was conducted to assess patient-centered care among inpatients in comprehensive hospitals through QR codes after discharge from September 2021 to December 2021 and had 5,222 respondents in Jiayuguan, Gansu. The questionnaire included a translated 6-item version of the PCC questionnaire, physician-induced behaviors, and patients' sociodemographic characteristics including gender, household registration, age, and income. Logistic regression analyses were conducted to assess whether PCC promoted self-reported health, the subjective necessity of hospitalization, and decreased physician-induced demand. The interactions between PCC and household registration were implemented to assess the effect of the difference between adequate and inadequate healthcare resources. Results PCC promoted the patient's self-reported physical (OR = 4.154, p < 0.001) and mental health (OR = 5.642, p < 0.001) and subjective necessity of hospitalization (OR = 6.160, p < 0.001). Meanwhile, PCC reduced physician-induced demand in advising to buy medicines outside (OR = 0.415, p < 0.001), paying at the outpatient clinic (OR =0.349, p < 0.001), issuing unnecessary or repeated prescriptions and medical tests (OR = 0.320, p < 0.001), and requiring discharge and readmitting (OR = 0.389, p < 0.001). Conclusion By improving health outcomes for inpatients and reducing the risk of physician-induced demand, PCC can benefit both patients and health insurance systems. Therefore, PCC should be implemented in healthcare settings.
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Affiliation(s)
- Chenhao Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xian
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiantian Jing
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mayangzong Bai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueyuan Li
- Health Commission of Shanghai Huangpu, Shanghai, China
| | - Jiahui Li
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huigang Liang
- Department of Business and Information Technology, Fogelman College of Business and Economics, University of Memphis, Memphis, TN, United States
| | - Guangjun Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Zhiruo Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lee DG, Choi MY. [Effects of Emotional Intelligence on Job Satisfaction of Pediatric Nurses: The Mediating Effect of Communication Skills and Pediatric Nurse-Parent Partnership]. J Korean Acad Nurs 2023; 53:514-524. [PMID: 37977562 DOI: 10.4040/jkan.23044] [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: 03/14/2023] [Revised: 06/19/2023] [Accepted: 08/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE This study aimed to identify the mediating effects of communication skills and pediatric nurse-parent partnership on the relationship between emotional intelligence and job satisfaction among pediatric nurses. METHODS A survey was administered to 205 pediatric nurses working in children's, general, and tertiary hospitals situated in Chungcheong province and Seoul. Data were collected in August and September 2022. The collected data were analyzed using SPSS Statistics version 26.0 along with the PROCESS macro program. RESULTS Emotional intelligence had a significant effect, and was a critical factor affecting the job satisfaction of pediatric nurses. Furthermore, communication skills and nurse-parent partnership had a serial double mediating effect. CONCLUSION These findings underscore the significance of conducting job satisfaction improvement programs, including strategies for augmenting emotional intelligence, bolstering communication skills, and fostering nurse-parent partnership.
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Affiliation(s)
- Da Gyeon Lee
- Department of Nursing Science, Chungbuk National University, Cheongju, Korea
| | - Mi-Young Choi
- Department of Nursing Science, Chungbuk National University, Cheongju, Korea.
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Jalali R, Jalali A, Jalilian M. Breaking bad news in medical services: a comprehensive systematic review. Heliyon 2023; 9:e14734. [PMID: 37025874 PMCID: PMC10070541 DOI: 10.1016/j.heliyon.2023.e14734] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 02/26/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE This study was performed with the aims of screening the previous studies on breaking bad news in all medical wards. METHODS Eligible observational studies were selected. The quality of the studies was assessed using the STROBE checklist. The findings were reported using Garrard's table. All the stages of the present study were performed in terms of the PRISMA statement. RESULTS Totally, 40 articles were included in the study and 96 items were extracted. The results show that breaking bad news is a recipient-centered process. Respect, empathy, and support were reported. The news presenters are better to use guidelines based on evidence-based findings. It is suggested that the presenter should use simple and understandable content. Moreover, suitable time and space are important to present the news. The results show the importance of paying enough attention to the emotions of the recipient and the need to provide support after breaking bad news. CONCLUSION The recipient must be the center of the programs. It is necessary to pay attention to the characteristics of the news presenter, the news content, and finally the support.Practice Implication: Understand the recipient, trained presenter, and use of the evidence-based results, improve the breaking bad news outcome.
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Affiliation(s)
- Rostam Jalali
- Nursing Department, Nursing & Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalali
- Department of Psychiatric Nursing, Nursing & Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Jalilian
- Nursing Department, Nursing & Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Kruser JM, Solomon D, Moy JX, Holl JL, Viglianti EM, Detsky ME, Wiegmann DA. Impact of Interprofessional Teamwork on Aligning Intensive Care Unit Care with Patient Goals: A Qualitative Study of Transactive Memory Systems. Ann Am Thorac Soc 2023; 20:548-555. [PMID: 36607704 PMCID: PMC10112416 DOI: 10.1513/annalsats.202209-820oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/06/2023] [Indexed: 01/07/2023] Open
Abstract
Rationale: Although aligning care with patient goals is fundamental to critical care, this process is often delayed and leads to conflict among patients, families, and intensive care unit (ICU) teams. Interprofessional collaboration within ICU teams is an opportunity to improve goal-aligned care, yet this collaboration is poorly understood. A better understanding of how ICU team members work together to provide goal-aligned care may identify new strategies for improvement. Objectives: Transactive memory systems is a theory of group mind that explains how high-performing teams use a shared memory and collective cognition. We applied this theory to characterize the process of interprofessional collaboration within ICU teams and its relationship with goal-aligned care. Methods: We conducted a secondary analysis of focus group (n = 10) and semistructured interview (n = 8) transcripts, gathered during a parent study at two academic medical centers on the process of ICU care delivery in acute respiratory failure. Participants (N = 70) included interprofessional ICU and palliative care team members, surrogates, and patient survivors. We used directed content analysis, applying transactive memory systems theory and its major components (specialization, coordination, credibility) to examine ICU team collaboration. Results: Participants described each ICU profession as having a specialized role in aligning care with patient goals. Different professions have different opportunities to gather knowledge about patient goals and priorities, which results in dispersion of this knowledge among different team members. To share and use this dispersed knowledge, ICU teams rely on an informal coordination process and "side conversations." This process is a workaround for formal channels (e.g., health records, interprofessional rounds) that do not adequately convey knowledge about patient goals. This informal process does not occur if team members are discouraged from asserting their knowledge because of hierarchy or lack of psychological safety. Conversely, coordination succeeds when team members recognize each other as credible sources of valued knowledge. Conclusions: We found that ICU team members work together to align care with patient goals and priorities, using transactive memory systems. The successful function of these systems can be disrupted or promoted by ICU organizational and cultural factors, which are potential targets for efforts to increase goal-aligned care.
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Affiliation(s)
| | - Demetrius Solomon
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin
| | - Joy X. Moy
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, and
| | - Jane L. Holl
- Department of Neurology, Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Elizabeth M. Viglianti
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Michael E. Detsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Douglas A. Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin
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Janerka C, Leslie GD, Gill FJ. Development of patient-centred care in acute hospital settings: A meta-narrative review. Int J Nurs Stud 2023; 140:104465. [PMID: 36857979 DOI: 10.1016/j.ijnurstu.2023.104465] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context. AIM To understand the development of patient-centred care in the context of acute hospital settings over the past decade. METHODS A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic. RESULTS One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care. CONCLUSIONS Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions. TWEETABLE ABSTRACT Patient-centred care in acute care settings - we have arrived! Is it sustainable?
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Affiliation(s)
- Carrie Janerka
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia.
| | - Gavin D Leslie
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia
| | - Fenella J Gill
- School of Nursing, Curtin University, Western Australia, Australia; Perth Children's Hospital, Child and Adolescent Health Service, Western Australia, Australia
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Acosta-Hernández C, Fernández-Castillo RJ, Montes-Vázquez M, González-Caro MD. Is caring for pressure ulcers in the intensive care unit in Spain still a challenge? A qualitative study on nurses' perceptions. J Tissue Viability 2023; 32:114-119. [PMID: 36529583 DOI: 10.1016/j.jtv.2022.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The incidence of pressure ulcers is an indicator of quality in intensive care units. Due to their frequency and severity, they are identified as a problem of great importance, where the well-being of patients and relatives is compromised, also generating a high healthcare cost. Nurses are primarily responsible for the care of pressure ulcers, however, the existing literature exposes a clear lack of knowledge regarding its prevention and treatment. OBJECTIVES To explore the attitudes, knowledge and perceived barriers by intensive care nurses regarding pressure ulcers treatment and prevention in a critical care setting. DESIGN A descriptive qualitative study has been carried out through semi-structured interviews with 22 intensive care nurses from two tertiary university hospitals in Spain. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used to reinforce the methodological approach of the study. FINDINGS From the collected data, 4 main themes emerged: "lack of specific knowledge about pressure ulcers in intensive care", "continuity of care: the main problem to solve", "teamwork and pressure ulcers: gasping for improvement" and "Skin care as another vital sign". CONCLUSION Most intensive care nurses consider that they do not have sufficient knowledge regarding pressure ulcers. The nurses' attitudes are positive, however, an ineffective transmission of information and registration regarding ulcers is perceived. Regarding the treatment of pressure ulcers, the lack of continuity of care and updated knowledge/training have been the main barriers. In terms of prevention, the most mentioned barriers have been the clinical condition of the patient and the lack of personnel, despite the level of knowledge.
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Affiliation(s)
- Claudia Acosta-Hernández
- Emergency Department, San Juan de Dios Hospital, Avda. San Juan de Dios, s/n, 18001, Bormujos, Seville, Spain
| | - Rafael-Jesús Fernández-Castillo
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Avenzoar St., 6, 41009, Seville, Spain; Intensive Care Clinical Unit, University Hospital Virgen Macarena, Dr. Fedriani St., 3, 41009, Seville, Spain. https://twitter.com/RJFernandez92
| | - Manuel Montes-Vázquez
- Intensive Care Department, University Hospital Virgen de Valme, Crta, de Cádiz, km 548, 41014, Seville, Spain
| | - María-Dolores González-Caro
- Intensive Care Clinical Unit, University Hospital Virgen Macarena, Dr. Fedriani St., 3, 41009, Seville, Spain
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11
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Karlsen MW, Holm A, Kvande ME, Dreyer P, Tate JA, Heyn LG, Happ MB. Communication with mechanically ventilated patients in intensive care units: A concept analysis. J Adv Nurs 2023; 79:563-580. [PMID: 36443915 PMCID: PMC10099624 DOI: 10.1111/jan.15501] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to perform a concept analysis of communication with mechanically ventilated patients in intensive care units and present a preliminary model for communication practice with these patients. DESIGN The Im & Meleis approach for concept analysis guided the study. SEARCH METHODS A literature search was performed in January 2022 in MEDLINE, Embase, CINAHL, psycINFO and Scopus, limited to 1998-2022. The main medical subject headings search terms used were artificial respiration, communication and critical care. The search resulted in 10,698 unique references. REVIEW METHODS After a blinded review by two authors, 108 references were included. Core concepts and terminology related to communication with mechanically ventilated patients were defined by content analytic methods. The concepts were then grouped into main categories after proposing relationships between them. As a final step, a preliminary model for communication with mechanically ventilated patients was developed. RESULTS We identified 39 different phrases to describe the mechanically ventilated patient. A total of 60 relevant concepts describing the communication with mechanically ventilated patients in intensive care were identified. The concepts were categorized into five main categories in a conceptual map. The preliminary model encompasses the unique communication practice when interacting with mechanically ventilated patients in intensive care units. CONCLUSION Highlighting different perspectives of the communication between mechanically ventilated patients and providers through concept analysis has contributed to a deeper understanding of the phenomena and the complexity of communication when the patients have limited possibilities to express themselves. IMPACT A clear definition of concepts is needed in the further development of guidelines and recommendations for patient care in intensive care, as well as in future research. The preliminary model will be tested further. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as this is a concept analysis of previous research.
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Affiliation(s)
| | - Anna Holm
- Department of Public HealthAarhus UniversityAarhus CDenmark
- Department of Intensive CareAarhus University HospitalAarhusDenmark
| | - Monica Evelyn Kvande
- Department for postgraduate studiesLovisenberg Diaconal University CollegeOsloNorway
| | - Pia Dreyer
- Department of Public HealthAarhus UniversityAarhus CDenmark
- Department of Intensive CareAarhus University HospitalAarhusDenmark
| | - Judith Ann Tate
- Center of Healthy Aging, Self‐Management and Complex CareThe Ohio State University College of NursingColumbusOhioUSA
| | - Lena Günterberg Heyn
- Center for Health and Technology, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayDrammenNorway
| | - Mary Beth Happ
- Center of Healthy Aging, Self‐Management and Complex CareThe Ohio State University College of NursingColumbusOhioUSA
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Kim EK, Cho IY, Yun JY, Park B. Factors influencing neonatal intensive care unit nurses' parent partnership development. J Pediatr Nurs 2023; 68:e27-e35. [PMID: 36411178 DOI: 10.1016/j.pedn.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonatal nurses play an important role in the development of effective partnerships, as they have more consistent interactions with the patients' parents and can encourage parental involvement. This study aimed to identify factors influencing neonatal intensive care unit (NICU) nurses' development of partnerships with parents of high-risk infants in South Korea based on King's interacting systems theory. METHODS We collected data utilizing a structured questionnaire, which included the following variables: developmental supportive nursing competency, empowerment, emotional intelligence, patient-centered communication skills, interpersonal competence, nursing work environment, and nurse-parent partnership. The participants were 140 pediatric nurses with at least one year of NICU experience in South Korea. We used SPSS/WIN 26.0 to analyze the data. FINDINGS Of the factors evaluated, empowerment (β = 0.35, p < 0.001), patient-centered communication skills (β = 0.25, p < 0.01), interpersonal competence (β = -0.27, p = 0.001), emotional intelligence (β = 0.25, p = 0.005), age (β = -0.15, p < 0.01), and gender (β = 0.12, p = 0.03) explained 62.4% of the total variance of the nurse-parent partnership. Our results identify the factors affecting NICU nurses' development of partnerships with parents of high-risk infants. IMPLICATIONS FOR PRACTICE Strategies and efforts to enhance the nurse-parent relationship must consider improving nurse empowerment, intelligence, and interpersonal factors.
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Affiliation(s)
- Eun Kyoung Kim
- Chonnam National University Hospital, Gwang-ju, South Korea
| | - In Young Cho
- College of Nursing, Chonnam National University, South Korea.
| | - Ji Yeong Yun
- Department of Nursing, Jesus University, South Korea
| | - Bobae Park
- Department of Nursing, Seoul National University Hospital, Department of Nursing, College of Nursing, Yonsei University, South Korea
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13
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Jin J, Son YJ, Tate JA, Choi J. Challenges and Learning Needs of Nurse-Patients' Family Communication: Focus Group Interviews With Intensive Care Unit Nurses in South Korea. Eval Health Prof 2022; 45:411-419. [PMID: 35337208 PMCID: PMC9630962 DOI: 10.1177/01632787221076911] [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] [Indexed: 12/29/2022]
Abstract
Intensive care unit (ICU) nurses are expected to facilitate effective day-to-day communication with patients and family members at the bedside. To date, communication training for ICU health care professionals has targeted mainly intensivists-in-training, but there is limited data on communication experience and needs to be evaluated among ICU nurses. This qualitative study used focus group interviews to explore daily communication experiences with patients' families and communication training needs and preferences among ICU nurses in South Korea. Five focus group interviews were conducted with 27 ICU nurses (4-6 nurses per group). The results of inductive qualitative content analysis highlighted four main categories: "Perceived difficulties during communication," "burden from working conditions," "endeavors to promote communication skills," and "strategies for cultivating effective communication." Regarding suggestions for future communication training, nurses preferred interactive learning with peer-support over traditional methods (e.g., lectures). Nurses also suggested that communication training for ICU nurses should include learning skills appropriate for difficult situations (e.g., angry family members). Findings from this study can serve as a framework for stakeholders in ICU care and healthcare education (e.g., hospital and nursing administrators, nurse educators) when designing communication training to support ICU nurses with their practical knowledge and communication skills.
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Affiliation(s)
- Juhye Jin
- Department of Nursing, College of
Health and Life Science, Korea National University of
Transportation, Jeungpyeong, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Judith A. Tate
- The Ohio State University, College of
Nursing, Columbus, OH, USA
| | - JiYeon Choi
- Mo-Im Kim Nursing Research
Institute, Yonsei University College of
Nursing, Seoul, South Korea,JiYeon Choi, Yonsei University College of
Nursing, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
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14
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Dees ML, Carpenter JS, Longtin K. Communication Between Registered Nurses and Family Members of Intensive Care Unit Patients. Crit Care Nurse 2022; 42:25-34. [DOI: 10.4037/ccn2022913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background
Effective communication between intensive care unit patients and their families and nurses promotes relationship-centered care and improves nurses’ ability to meet patient and family needs. However, communication with these patients is challenging because of their critical illness. Families often become surrogate decision makers for adult intensive care unit patients.
Objective
To systematically assess available evidence on communication between adult intensive care unit patients and their families and nurses as the initial step in developing nursing strategies to strengthen communication skills.
Methods
In this integrative review, the method of Whittemore and Knafl was used to synthesize findings from qualitative and quantitative (descriptive and experimental) research.
Results
The review revealed a variety of research designs, measurement tools, and types of interventions. The qualitative findings suggest that nurses can strengthen relationship-centered care by regularly updating patients’ families and providing information that can assist with decision-making. The quantitative findings suggest that nurses should be mindful of family members’ needs for assurance, comfort, and support. Providing information on patient status can help alleviate family concerns.
Conclusions
Improved communication between patients and families and intensive care unit nurses is essential to strengthen relationship-centered care. Additional research is needed to better understand the communication needs of adult patients and their families in the intensive care unit.
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Affiliation(s)
- Mandy L. Dees
- Mandy L. Dees is a doctoral student, Indiana University School of Nursing, Indianapolis, Indiana
| | - Janet S. Carpenter
- Janet S. Carpenter is Distinguished Professor and Audrey Geisel Endowed Chair in Innovation, Indiana University School of Nursing
| | - Krista Longtin
- Krista Longtin is an associate professor, Indiana University School of Liberal Arts, and assistant dean, Indiana University School of Medicine, Indianapolis, Indiana
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Díaz-Agea JL, Orcajada-Muñoz I, Leal-Costa C, Adánez-Martínez MG, De Souza Oliveira AC, Rojo-Rojo A. How Did the Pandemic Affect Communication in Clinical Settings? A Qualitative Study with Critical and Emergency Care Nurses. Healthcare (Basel) 2022; 10:373. [PMID: 35206987 PMCID: PMC8872094 DOI: 10.3390/healthcare10020373] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 01/10/2023] Open
Abstract
The objective of the present study was to determine the subjective impact of the pandemic due to COVID-19 on communication, as perceived by nurses working at emergency services and Intensive Care Units at various hospitals in the Region of Murcia (Spain). A qualitative study was conducted based on the content analysis of 12 semi-structured individual interviews. The participant recruitment process was performed through a snowball sampling technique. Four main dimensions, eleven categories, and two sub-categories were obtained: (1) communication (communicative expressions, both verbal and non-verbal-, and limitations); (2) emotional aspects (positive, negative); (3) overload (first wave, second wave, and third wave); and (4) relationships (health professionals-patients, healthcare professionals, patients-family, and family-health professionals). The main findings of the study show that communication was slightly affected during the pandemic, especially the non-verbal kind, with verbal communication maintained and, in some occasions, strengthened. The lack of training in communication skills and its influence on the management of difficult periods was another important finding. Communication in general deteriorated during the pandemic, especially during the initial waves. Non-verbal communication was more affected due to the use of Personal Protective Equipment and the initial fear of infection, with this finding strongly observed in departments such as emergencies or critical care. The nurses who were interviewed underlined negative emotional aspects associated with a deficit in communication. The positive aspects described were associated with the creation of mutual support spaces and the group cohesion of the work teams during the pandemic. As an implication for current and future clinical practice, we recommend a coordinated institutional response to mitigate the potential emotional effects on workers by designing appropriate communication and emotional expression protocols.
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Affiliation(s)
- José Luis Díaz-Agea
- Faculty of Nursing, Universidad Católica de Murcia, 30107 Guadalupe, Spain; (J.L.D.-A.); (I.O.-M.); (A.C.D.S.O.); (A.R.-R.)
| | - Irene Orcajada-Muñoz
- Faculty of Nursing, Universidad Católica de Murcia, 30107 Guadalupe, Spain; (J.L.D.-A.); (I.O.-M.); (A.C.D.S.O.); (A.R.-R.)
| | - César Leal-Costa
- Faculty of Nursing, Universidad de Murcia, 30120 El Palmar, Spain
| | | | | | - Andrés Rojo-Rojo
- Faculty of Nursing, Universidad Católica de Murcia, 30107 Guadalupe, Spain; (J.L.D.-A.); (I.O.-M.); (A.C.D.S.O.); (A.R.-R.)
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16
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Andersson M, Nordin A, Engström Å. Critical care nurses' experiences of working during the first phase of the COVID-19 pandemic - Applying the Person-centred Practice Framework. Intensive Crit Care Nurs 2021; 69:103179. [PMID: 34895797 PMCID: PMC8595352 DOI: 10.1016/j.iccn.2021.103179] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/24/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022]
Abstract
AIM The aim of the study was to deductively study person-centred care, based on critical care nurses' experiences during the first phase of the CoViD-19 pandemic. DESIGN The study used a qualitative design. METHOD Data collection was conducted as individual interviews and was analysed with qualitative content analysis with a deductive approach. PARTICIPANTS Six critical care nurses working in a special CoViD-19 intensive care unit during the first phase of the pandemic participated. FINDINGS The findings are presented within the four domains of person-centred practice: the prerequisites, the care environment, person-centred processes and person-centred outcomes. While the ambition and knowledge about how to work in accordance with person-centred practice were high, there were several obstacles to perform it. CONCLUSION We need to prepare ahead of time so that nurses have optimal organisational prerequisites to be able to work in accordance with person-centred practice, also during pandemics and other crisis, which means to be able to give nursing care in accordance with the ill person's needs and resources.
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Affiliation(s)
- Maria Andersson
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden
| | - Anna Nordin
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden; Karlstad University, Department of Health Science, Faculty of Health, Science, and Technology, Sweden
| | - Åsa Engström
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden.
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Abstract
Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.
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18
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Mei-Sheng Riley M, Olans R. Implementing an Antimicrobial Stewardship Program in the Intensive Care Unit by Engaging Critical Care Nurses. Crit Care Nurs Clin North Am 2021; 33:369-380. [PMID: 34742494 DOI: 10.1016/j.cnc.2021.07.001] [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] [Indexed: 11/15/2022]
Abstract
The continuing rise in the incidence of multidrug-resistant organism infections has made combating this grave threat a national imperative. One of the most potent weapons in our arsenal against such organisms is the prudent use of antibiotics. Antimicrobial stewardship (AMS) programs aim to slow the development of antimicrobial resistance through judicious, monitored use of antibiotics. Traditionally, AMS programs have included pharmacists and physicians with training in AWS, infectious disease physicians, hospital leadership, microbiologists, and infection prevention professionals. Nurses are missing from AMS programs, especially intensive care nurses. Critical care nurses provide the majority of patient care to ICU patients and monitor the progress of the patient's condition. The ICU nurse is an obvious asset to the AMS programs. ICU nurses are well-educated autonomous professionals with a unique role in coordinating with the critical care team. Critical care nurses already perform numerous nursing tasks with AWS functions. This, together with their unique perspective makes them a valuable asset that has often been overlooked. Traditionally, perceived barriers have kept ICU nurses from joining AMS teams. By removing these barriers and engaging critical care nurses in the important work of AWS, we can strengthen our AMS team and achieve optimal outcomes for our patients.
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Affiliation(s)
- May Mei-Sheng Riley
- Providence Saint Joseph Health System, 2700 Dolbeer Street, Eureka, CA 95501, USA; Stanford Health Care, 300 Pasteur Drive, Room H0105, M/C 5221, Stanford, CA 94305-5623, USA.
| | - Rita Olans
- MGH Institute of Health Professions, School of Nursing, 36 First Avenue, Boston, MA 02128, USA
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19
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Parravicini S, Provenzi L, Barello S, Nania T, Grumi S, Rinaldi E, Orcesi S, Borgatti R. The Experience of Child Neuropsychiatry Residents who Volunteered in Italian COVID-19-Designated Hospitals. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:587-592. [PMID: 33851341 PMCID: PMC8043436 DOI: 10.1007/s40596-021-01442-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE During the first months of 2020, the coronavirus disease of 2019 (COVID-19) spread rapidly and soon reached a pandemic level. With the increasing number of hospitalizations, medical and nursing personnel resources were soon inadequate. As a consequence, medical volunteers became a key human resource and young medical residents in any specialty were hired on a voluntary basis to contribute to take care of patients with COVID-19. This study reports on the lived experience of residents in child neuropsychiatry who volunteered in Italian hotspot COVID-19-designated hospitals during the epidemic outbreak. METHODS A phenomenological, qualitative approach using semi-structured interviews with open-ended questions was used to obtain in-depth narratives of the experience of residents in child neuropsychiatry volunteering in North Italy COVID-19-designated hospitals. All residents (n = 8) participated in the study. Interviews were conducted by an expert researcher trained in qualitative methods. Data analysis was performed by independent coders. RESULTS Five core themes could be identified from the interviews: acting as mediators on two fronts, facing the shock of COVID-19 reality, capitalizing from specialty education, growing as persons and professionals, and humanizing medical care. CONCLUSIONS This study is unique in providing an in-depth understanding of the experience of young residents in child neuropsychiatry volunteering in general hospitals during the COVID-19 pandemic in Northern Italy. The findings suggest that this experience may be highly beneficial for both the residents and the hospital quality of care. Insights for an accurate planning of residents' engagement in future healthcare emergencies are provided.
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Affiliation(s)
- Stefano Parravicini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, PV, Italy.
| | - Serena Barello
- Department of Psychology, Università Cattolica, Milan, MI, Italy
| | - Tiziana Nania
- Department of Psychology, Università Cattolica, Milan, MI, Italy
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, PV, Italy
| | - Elisa Rinaldi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, PV, Italy
| | - Simona Orcesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
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20
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Judge H, Ceci C. Problematising assumptions about 'centredness' in patient and family centred care research in acute care settings. Nurs Inq 2021; 29:e12448. [PMID: 34453480 DOI: 10.1111/nin.12448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
Over the last two decades significant efforts have been made to implement patient and family 'centred' care as both a practical and moral imperative for adult acute care delivery. Although many resources have been developed and adopted by institutions, research suggests persistent and diverse barriers to implementing and achieving patient and family 'centred' care in adult acute care practice settings. These issues in implementation suggest re-examining the nature of 'centredness' in care may be useful. A structured problematisation method, as outlined by Alvesson and Sandberg, is utilised to identify and analyse assumptions about the central notions of 'centring' that inform patient and family centred care intervention research. From our analysis, we highlight three predominant areas within 'centring' intervention research that may benefit from rethinking: Vitruvian spatiality, democratising care, and 'centring' positioned as primarily a problem and accomplishment for nursing. As a challenge to these assumptions, we argue for the adoption of theoretical lenses that 'de-centre' individual actors to better account for complex relations among multiple actors, both human and nonhuman, which work to involve patients and families in care practices.
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Affiliation(s)
- Harkeert Judge
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Ceci
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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21
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Anna S, Catharina F, Ann-Charlotte F. The core of patient-participation in the Intensive Care Unit: The patient's views. Intensive Crit Care Nurs 2021; 68:103119. [PMID: 34391629 DOI: 10.1016/j.iccn.2021.103119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/08/2021] [Accepted: 07/17/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Patient participation is an established concept in public welfare. However, reports of the phenomenon of patient participation during intensive care from the patient's point of view are scarce. Therefore, the aim of this study was to explore the meaning of patient participation in the intensive care unit from the patient's perspective. RESEARCH DESIGN A qualitative design was used for the purpose of the study with a purposive convenient sample of nine adult patients with memories from their intensive care stay. METHOD Data was collected through individual interviews and analysed using a phenomenological hermeneutical method. FINDINGS The results of our study show a variety of meanings and degrees of participation that continuously move on a sliding scale from acting as a captain to feelings of being on an isolated island. Patient participation varied due to individual cognitive abilities and individual preferences, and the caregiver's attention altered between the body and the person through the continuum of care. CONCLUSION Patient participation during ICU care is more than participation in decision-making processes or direct patient care decisions. An understanding of the concept participation from the individual patient is necessary to support person centred care and the patient's relatives play an important role in during the entire care process.
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Affiliation(s)
- Slettmyr Anna
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institute, SE-141 52 Stockholm, Sweden.
| | - Frank Catharina
- School of Health and Caring Sciences, Linnaeus University, SE-351 95 Växjö, Sweden.
| | - Falk Ann-Charlotte
- Department for Health Promoting Science, Sophiahemmet University, SE-114 86 Stockholm, Sweden.
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22
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Al-Yahyai Rn Bsn ANS, Arulappan Rn Rm Bsc N Msc N PhD N DNSc J, Matua GA, Al-Ghafri Rn Bsn SM, Al-Sarakhi Rn Bsn SH, Al-Rahbi Rn Bsn KKS, Jayapal SK. Communicating to Non-Speaking Critically Ill Patients: Augmentative and Alternative Communication Technique as an Essential Strategy. SAGE Open Nurs 2021; 7:23779608211015234. [PMID: 34159256 PMCID: PMC8186114 DOI: 10.1177/23779608211015234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Communication with hospitalized patients is crucial to improve the quality and safety of health care. Methods The study assessed the communication methods used by nurses while communicating to non-speaking critically ill patients. The participants included staff nurses working in ICU, CICU, HD units of neuro- surgical, orthopedic, medical and oncology wards. Purposive sampling technique was used to recruit a total number of 194 nurses. The communication methods used were assessed by a questionnaire comprised of a list of 21 strategies used to communicate with non-speaking patients. Results The most commonly used strategies were reading the patient’s mouthing words, encouraging the patient by telling them that they are doing well and nurses helping them to get better, assessing the patients for their communication ability, “thumps up” to indicate “yes”, “shake head” indicating “no”, use OK, or point to body parts, speaking slowly and waiting for the patient’s response, spending time to listen patiently to what the patient say and touching the non-speaking critically ill patient when the nurse speaks with the patient. Conclusion The study reported that the nurses used variety of communication strategies while communicating to non- speaking critically ill patients. However very few nurses used Augmentative and alternative communication strategies to communicate to non-speaking critically ill patients. The study recommends the importance of establishing Augmentative and Alternative Communication strategies in the hospitals.
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Affiliation(s)
| | | | - Gerald Amandu Matua
- Department of Fundamentals and Administration, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
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23
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Kuyler A, Johnson E. Patient and nurse content preferences for a communication board to facilitate dialogue in the intensive care unit. Intensive Crit Care Nurs 2020; 63:103005. [PMID: 33358517 DOI: 10.1016/j.iccn.2020.103005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The main aim of this study was to identify patient and nurse content preferences for a communication board to facilitate effective communication (dialogue) in the critical care unit. RESEARCH DESIGN A qualitative research design focusing on explorative and descriptive components was used to address the aim of the research study. The study employed two participant groups. Semi-structured interviews and focus group discussions were conducted with critically ill patients (N = 10) and critical care nurses (N = 30). SETTING The study was conducted in four different private hospitals of the same hospital group in Gauteng, South Africa. FINDINGS Four distinct themes were identified in the research regarding the vocabulary items that participants would like to have included. CONCLUSION The findings suggest that patients perceive a communication board to be valuable in enhancing communication in the critical care unit; that cultural and linguistic diversity should be considered; and that patients and nurses have varying opinions on topics of priority during communication.
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Affiliation(s)
- Ariné Kuyler
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20 Hatfield, 0028, South Africa.
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20 Hatfield, 0028, South Africa.
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Jowkar N, Fjeldsø N, Nørgaard LS, Sporrong SK, Jacobsen R, Kaae S. A Presentation of Central Communication Aspects in the Patient-Provider Relationship-Potential Learnings for Community Pharmacists. PHARMACY 2020; 8:pharmacy8040241. [PMID: 33352836 PMCID: PMC7768490 DOI: 10.3390/pharmacy8040241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Several studies have shown that communication between patients and HCPs is still not optimal in integrating patients’ perspectives on how best to manage their diseases and their medication. One such area where encounters between patients and professionals still needs to develop to better incorporate the patient’s perspective is pharmacy practice. The aim of this study was therefore to explore and present new typologies and communication aspects of HCP-patient relationships since a comprehensive literature search in 1997 conducted by Sondell and Söderfeldt, and relate the findings to pharmacy practice. In total, 11 articles were identified by applying the techniques of a purposeful literature search. The articles covered aspects of: shifting and adapting roles during the encounter, techniques to ensure individualizing in the encounter, avoiding inappropriate routines, coping with internet-informed patients, achieving mutual goals, dealing with uncertainty including avoiding rigid preconceptions, using social conversation, incorporating patients’ prior experiences, aligning language, adapting greetings and exploring the cultures and communication patterns of patients from other ethnic backgrounds. The variety of these communication aspects points to the immense complexity of communication as a practice discipline. This article has presented some of the literature that pharmacists can consult, in the endeavor of improving their communication practices.
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Affiliation(s)
- Nima Jowkar
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
| | - Nina Fjeldsø
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
| | - Lotte Stig Nørgaard
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
| | - Sofia Kälvemark Sporrong
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
- Department of Pharmacy, Uppsala University, 752 36 Uppsala, Sweden
| | - Ramune Jacobsen
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
| | - Susanne Kaae
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
- Correspondence: ; Tel.: +45-3533-6273
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25
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Holm A, Viftrup A, Karlsson V, Nikolajsen L, Dreyer P. Nurses' communication with mechanically ventilated patients in the intensive care unit: Umbrella review. J Adv Nurs 2020; 76:2909-2920. [PMID: 32893350 DOI: 10.1111/jan.14524] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/30/2022]
Abstract
AIM To conduct a review summarizing evidence concerning communication with mechanically ventilated patients in the intensive care unit (ICU). BACKGROUND ICU patients undergoing mechanical ventilation are unable to communicate verbally, causing many negative emotions. Due to changes in sedation practice, a growing number of patients are conscious and experience communication difficulties. DESIGN The umbrella review method guided by the Joanna Briggs Institute was applied. DATA SOURCES A systematic search was done in the Cochrane Library, the Joanna Briggs Institute database, Cinahl, Pubmed, PsycINFO and Scopus between January -April 2019. Search terms were 'nurse-patient communication', 'mechanical ventilation', 'intensive care', and 'reviews as publication type'. Literature from 2009-2019 was included. REVIEW METHODS Following recommendations by the Joanna Briggs Institute, a quality appraisal, data extraction, and synthesis were done. RESULTS Seven research syntheses were included. There were two main themes and six subthemes: (1) Characterization of the nurse-patient communication: (a) Patients' communication; (b) Nurses' communication; (2) Nursing interventions that facilitate communication: (a) Communication assessment and documentation; (b) Communication methods and approaches; (c) Education and training of nurses; and (d) Augmentative and alternative communication. CONCLUSION Nurse-patient communication was characterized by an unequal power relationship with a common experience - frustration. Four key interventions were identified and an integration of these may be key to designing and implementing future ICU communication packages. IMPACT Nurse-patient communication is characterized by an unequal power relationship with one joint experience - frustration. Four key interventions should be integrated when designing and implementing communication packages in the ICU. Findings are transferable to ICU practices where patients are conscious and experience communication difficulties.
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Affiliation(s)
- Anna Holm
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Anette Viftrup
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lone Nikolajsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Dreyer
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
- University of Bergen, Bergen, Norway
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Abstract
Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.
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Affiliation(s)
- JiYeon Choi
- Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Korea
| | - Judith A Tate
- Center of Healthy Aging, Self-Management and Complex Care, Undergraduate Nursing Honors Program, The Ohio State University College of Nursing, 386 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA.
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Albanesi B, Nania T, Barello S, Villa G, Rosa D, Caruso R, Udugampolage NS, Casole L, Dellafiore F. Lived experience of patients in
ICU
after cardiac surgery: A phenomenological study. Nurs Crit Care 2020; 27:204-213. [DOI: 10.1111/nicc.12562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Beatrice Albanesi
- Department of Medicine and Psychology Sapienza University Rome Italy
| | - Tiziana Nania
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| | - Serena Barello
- Department of Psychology, EngageMinds Hub Research Center Università Cattolica del Sacro Cuore Milan Italy
| | | | - Debora Rosa
- IRCCS Istituto Auxologico Italiano Milan Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| | | | - Lorenzo Casole
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit IRCCS Policlinico San Donato Milan Italy
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Yoo HJ, Shim J. Effects of a person-centred care intervention in an intensive care unit: Using mixed methods to examine nurses' perspectives. J Nurs Manag 2020; 28:1295-1304. [PMID: 32589762 DOI: 10.1111/jonm.13081] [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: 12/07/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
AIM We identified nurses' experiences and changes in person- and family-centred care (PFCC) after applying a family-visiting programme in an intensive care unit (ICU). BACKGROUND Critical care provision is shifting to include communication among patients, families and health care providers. METHODS We used mixed methodology and a group pre- and post-test design. In 2019, 30 ICU nurses completed an 8-week programme, including keeping a diary and completing fundamental care activities. A survey of PFCC nursing performance was completed pre- and post-programme, and 15 nurses were interviewed post-programme. Performance differences were examined through paired t tests; qualitative data were analysed by thematic analysis. RESULTS The pre- and post-scores were 3.06 ± 0.34 and 4.00 ± 0.29, respectively (t = 17.38, p =.000), and five main themes and 13 subtopics were revealed. Most nurses 'discovered the importance of nursing through a truthful relationship with ICU patients' families'. CONCLUSION For effective PFCC, changes in nurses' perceptions and hospital organisation are required, such as improving the ICU working environment, assigning suitable health care personnel to provide care and implementing open-visit programmes. IMPLICATIONS FOR NURSING MANAGEMENT Hospital policymakers and nurse managers should take care to provide staff support and high-quality patient care to realize effective PFCC.
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Affiliation(s)
- Hye Jin Yoo
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - JaeLan Shim
- Department of Nursing, College of Medicine, Dongguk University, Gyeongju, South Korea
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Yoo HJ, Lim OB, Shim JL. Critical care nurses' communication experiences with patients and families in an intensive care unit: A qualitative study. PLoS One 2020; 15:e0235694. [PMID: 32645062 PMCID: PMC7347110 DOI: 10.1371/journal.pone.0235694] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/21/2020] [Indexed: 11/25/2022] Open
Abstract
This study evaluated the communication experiences of critical care nurses while caring for patients in an intensive care unit setting. We have collected qualitative data from 16 critical care nurses working in the intensive care unit of a tertiary hospital in Seoul, Korea, through two focus-group discussions and four in-depth individual interviews. All interviews were recorded and transcribed verbatim, and data were analyzed using the Colaizzi’s method. Three themes of nurses’ communication experiences were identified: facing unexpected communication difficulties, learning through trial and error, and recognizing communication experiences as being essential for care. Nurses recognized that communication is essential for quality care. Our findings indicate that critical care nurses should continuously aim to improve their existing skills regarding communication with patients and their care givers and acquire new communication skills to aid patient care.
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Affiliation(s)
- Hye Jin Yoo
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Oak Bun Lim
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Jae Lan Shim
- College of Medicine, Department of Nursing, Dongguk University, Gyeongju, South Korea
- * E-mail:
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30
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Vennedey V, Hower KI, Hillen H, Ansmann L, Kuntz L, Stock S. Patients' perspectives of facilitators and barriers to patient-centred care: insights from qualitative patient interviews. BMJ Open 2020; 10:e033449. [PMID: 32376748 PMCID: PMC7223019 DOI: 10.1136/bmjopen-2019-033449] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Previous studies on patient-centred care (PCC) and its facilitators and barriers usually considered specific patient groups, healthcare settings and aspects of PCC or focused on expert perspectives. The objective of this study was to analyse patients' perspectives of facilitators and barriers towards implementing PCC. DESIGN We conducted semistructured individual interviews with chronically ill patients. The interviewees were encouraged to share positive and negative experiences of care and the related facilitators and barriers in all settings including preventive, acute and chronic health issues. Interview data were analysed based on the concept of content analysis. SETTING Interviews took place at the University Hospital Cologne, nursing homes, at participants' homes or by telephone. PARTICIPANTS Any person with at least one chronic illness living in the region of Cologne was eligible for participation. 25 persons with an average age of 60 years participated in the interviews. The participants suffered from various chronic conditions including mental health problems, oncological, metabolic, neurological diseases, but also shared experiences related to acute health issues. RESULTS Participants described facilitators and barriers of PCC on the microlevel (eg, patient-provider interaction), mesolevel (eg, health and social care organisation, HSCO) and macrolevel (eg, laws, financing). In addition to previous concepts, interviewees illustrated the importance of being an active patient by taking individual responsibility for health. Interviewees considered functioning teams and healthy staff members a facilitator of PCC as this can compensate stressful situations or lack of staff to some degree. A lack of transparency in financing and reimbursement was identified as barrier to PCC. CONCLUSION Individual providers and HSCOs can address many facilitators and barriers of PCC as perceived by patients. Large-scale changes such as reduction of administrative barriers, the expansion of care networks or higher mandatory nurse to patient ratios require political action and incentives. TRIAL REGISTRATION NUMBER DRKS00011925.
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Affiliation(s)
- Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Kira Isabel Hower
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Hendrik Hillen
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Lena Ansmann
- Department of Health Services Research, Division of Organizational Health Services Research, Faculty of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
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31
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Newey CR, George P, Honomichl R, Gomes J, Maraj A, Kinzy T, Conley S, Douglas B, Stoltz M, Hang D, Omer T, Abubakr S, Lynch G, Dani D, Katzan I. Satisfaction with Care and Satisfaction with Decision Making are Similar Regardless of Staffing Model in a Neurocritical Care Unit. Neurocrit Care 2020; 34:13-20. [PMID: 32323147 PMCID: PMC7222902 DOI: 10.1007/s12028-020-00967-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction Patient-centered care, particularly shared medical decision making, is difficult to measure in critically ill patients where decisions are often made by a designated surrogate, often receiving information from multiple providers with varying degrees of training. The purpose of this study was to compare short-term satisfaction with care and decision making in patients or surrogates between two neurocritical care units [one staffed by a neurocritical care attending and advanced practice providers (APPs) and one staffed by a neurocritical care attending and resident/fellow trainees] using the Family Satisfaction in the ICU (FS-ICU) survey. Methods Over a 6-month period, the FS-ICU was administered on a tablet device to patients or surrogates at least 24 h after admission and stored on REDCap database. Results One hundred and thirty-four patients or surrogates completed the FS-ICU. The response rates were 59.97% and 46.58% in the APP and trainee units, respectively. There were no differences in patient age, sex, ventilator days or ICU length of stay. Overall, there were no differences in satisfaction with care or perceived shared medical making between the units. Respondents who identified their relationship with the patient as “other” (not a spouse, parent, nor a sibling) were less satisfied with care. Additionally, surrogates who identified as parents of the patient were more satisfied with degree of shared medical decision making. Conclusion This study showed that: (1) collecting FS-ICU in a neurocritical care unit is feasible, (2) overall there is no difference in short-term satisfaction with care or shared decision making between a NICU staffed with trainees compared to one staffed with APPs, and (3) parents of patients have a higher short-term satisfaction with degree of shared medical decision making.
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Affiliation(s)
- Christopher R Newey
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA.
- Neurological Institute, Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Pravin George
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
- Case Western Reserve University, Cleveland, OH, 44195, USA
| | - Ryan Honomichl
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Joao Gomes
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Anita Maraj
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Tyler Kinzy
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
- Case Western Reserve University, Cleveland, OH, 44195, USA
| | - Sarah Conley
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Bradley Douglas
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Michael Stoltz
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - David Hang
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Tarig Omer
- Anesthesiology Institute, Cardiothoracic Anesthesia Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Samer Abubakr
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Gwen Lynch
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Dhimant Dani
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Irene Katzan
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Bayog KMS, Bello DMC, Benabaye JMP, Benegas TME, Benito ALM, Berioso MA, Parial LLB, Macindo JRB. A conjoint analysis of the communication preferences of registered nurses towards mechanically ventilated patients. Int J Nurs Pract 2020; 26:e12809. [DOI: 10.1111/ijn.12809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | - John Rey B. Macindo
- Faculty of Management and Development StudiesUniversity of the Philippines Open University Los Baños Laguna Philippines
- Nursing Service Division, AMOSUP Seamen's Hospital, Intramuros Manila Philippines
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Kermanshahi SMK, Zare A, Memarian R, Vanaki Z. Explaining of Nurses’ Perception of Professional Relationship in the Coronary Care Unit (CCU). ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7819] [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]
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Zoremba N, Coburn M, Schälte G. [Delirium in intensive care patients : A multiprofessional challenge]. Anaesthesist 2019; 67:811-820. [PMID: 30298270 DOI: 10.1007/s00101-018-0497-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Delirium is the most common form of cerebral dysfunction in intensive care patients and is a medical emergency that must be avoided or promptly diagnosed and treated. According to current knowledge the development of delirium seems to be caused by an interplay between increased vulnerability (predisposition) and simultaneous exposure to delirogenic factors. Since delirium is often overlooked in the clinical routine, a continuous screening for delirium should be performed. Due to the close connection between delirium, agitation and pain, sedation and analgesia must be evaluated at least every 8 h analogous to delirium screening. According to current knowledge, a multifactorial and multiprofessional approach is favored in the prevention and treatment of delirium. Non-pharmaceutical interventions through early mobilization, reorientation, sleep improvement, adequate pain therapy and avoidance of polypharmacy are of great importance. Depending on the clinical picture, different substances are used in symptom-oriented drug treatment of delirium. In order to achieve these diagnostic and therapeutic goals, an interdisciplinary treatment team consisting of intensive care, intensive care physicians, ward pharmacists, physiotherapists, nutrition specialists and psychiatrists is necessary in order to meet the requirements of the patient and their relatives.
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Affiliation(s)
- N Zoremba
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Sankt Elisabeth Hospital Gütersloh, Stadtring Kattenstroth 130, 33332, Gütersloh, Deutschland.
| | - M Coburn
- Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
| | - G Schälte
- Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
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Edeer AD, Bilik Ö, Kankaya EA. Thoracic and cardiovascular surgery patients: Intensive care unit experiences. Nurs Crit Care 2019; 25:206-213. [PMID: 31642579 DOI: 10.1111/nicc.12484] [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] [Received: 02/06/2019] [Revised: 09/02/2019] [Accepted: 10/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intensive care units are stressful places where patients experience physical and psychological discomfort. Understanding the experience of these patients regarding nursing care is very important. AIMS AND OBJECTIVES To determine the intensive care experiences of thoracic and cardiovascular surgery patients and the factors that affect them. DESIGN The research consists of two phases: quantitative and qualitative. METHODS This was a descriptive and cross-sectional study. Its research sample comprised 100 patients who spent at least one night in an intensive care unit after thoracic or cardiovascular surgery. The Intensive Care Experiences Scale (ICES) and the Numeric Rating Scale were used. Two open-ended questions were asked to the patients to understand what they felt when they were attached to mechanical ventilation and to describe their intensive care experiences. RESULTS The ICES mean score was 66.35 ± 6.88. Significant negative relationships were found between length of stay and severity of pain and ICES total scores. A significant difference was found between scale scores and being understood by health care professionals when attached to mechanical ventilation. The patients stated that, when they were attached to mechanical ventilation and during their stay in the intensive care unit, they experienced feelings of helplessness, uncertainty, and fear. They also experienced physical discomfort and reported no longer fearing death. CONCLUSION It was determined that patients partially positively perceived their experiences. It was found that they focused on coming out of surgery alive. The physical discomfort and negative emotions reported can be reduced or relieved by competent care. RELEVANCE TO CLINICAL PRACTICE The intensive care experiences and emotions of intensive care patients are important. Physical discomfort and negative emotions can be mitigated or alleviated by competent nursing care.
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Affiliation(s)
- Aylin Durmaz Edeer
- Surgical Nursing Department, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Özlem Bilik
- Surgical Nursing Department, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Eda A Kankaya
- Surgical Nursing Department, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
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Abstract
OBJECTIVES We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. STUDY SELECTION Original articles, review articles, and systematic reviews were considered. DATA EXTRACTION Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. DATA SYNTHESIS "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. CONCLUSIONS A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.
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Karlsen MMW, Ølnes MA, Heyn LG. Communication with patients in intensive care units: a scoping review. Nurs Crit Care 2019; 24:115-131. [PMID: 30069988 DOI: 10.1111/nicc.12377] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 05/02/2018] [Accepted: 06/13/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients in intensive care units are generally more conscious and alert when they are on mechanical ventilation than in previous years because of the many potential benefits of being under less sedation. The endotracheal tube blocks the vocal cords when patients are on ventilation, thus making it impossible to speak. Many patients report that they struggle to make themselves understood. AIM The aim of this study was to assess previous knowledge about interaction and communication between health care personnel and conscious and alert patients under mechanical ventilation in intensive care units. DESIGN AND METHODS A literature review was performed following the steps of a scoping review. Studies published between 1998 and 2017 were identified in several databases: Cinahl, Embase, Medline, PsycINFO and Scopus. The first search returned 7386 unique references. The inclusion criteria consisted of empirical studies or studies related to interactions between health care personnel and patients over 18 years of age on mechanical ventilation. The relevant studies were summarized in a standardized data-charting sheet. RESULTS The inclusion criteria were met by 46 articles; 16 were qualitative studies, 17 were quantitative, 6 were mixed-methods studies, and 7 were pilot or feasibility studies. Of the studies, 37 were from nurses, 4 from physicians, 4 from speech language pathologists and 1 from psychologists. The most common topics investigated in the studies were 'experiences with communication on mechanical ventilation' and 'communication exchanges'. CONCLUSIONS A variety of communication aids that appear to have some effect on patients should be made available in intensive care units. More multidisciplinary approaches in future studies could enhance the knowledge in the field. RELEVANCE TO CLINICAL PRACTICE The education of intensive care unit personnel in the use of such aids should be a prioritized field, as should be the implementation of a variety of communication aids.
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Affiliation(s)
| | - Mia Alexandra Ølnes
- Lovisenberg Diaconal University College, Lovisenberggt 15b, 0456 Oslo, Norway
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Wallander Karlsen M, Heggdal K, Finset A, Heyn LG. Attention‐seeking actions by patients on mechanical ventilation in intensive care units: A phenomenological‐hermeneutical study. J Clin Nurs 2018; 28:66-79. [DOI: 10.1111/jocn.14633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/06/2018] [Accepted: 07/15/2018] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Arnstein Finset
- Faculty of Medicine Institute of Basic Medical Sciences University of Oslo Oslo Norway
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Kalocsai C, Amaral A, Piquette D, Walter G, Dev SP, Taylor P, Downar J, Gotlib Conn L. "It's better to have three brains working instead of one": a qualitative study of building therapeutic alliance with family members of critically ill patients. BMC Health Serv Res 2018; 18:533. [PMID: 29986722 PMCID: PMC6038351 DOI: 10.1186/s12913-018-3341-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Studies in the intensive care unit (ICU) suggest that better communication between families of critically ill patients and healthcare providers is needed; however, most randomized trials targeting interventions to improve communication have failed to achieve family-centered outcomes. We aim to offer a novel analysis of the complexities involved in building positive family-provider relationships in the ICU through the consideration of not only communication but other important aspects of family-provider interactions, including family integration, collaboration, and empowerment. Our goal is to explore family members’ perspectives on the enablers and challenges to establishing therapeutic alliance with ICU physicians and nurses. Methods We used the concept of therapeutic alliance as an organizational and analytic tool to conduct an interview-based qualitative study in a 20-bed adult medical-surgical ICU in an academic hospital in Toronto, Canada. Nineteen family members of critically ill patients who acted as substitute decision-makers and/or regularly interacted with ICU providers were interviewed. Participants were sampled purposefully to ensure maximum variation along predetermined criteria. A hybrid inductive-deductive approach to analysis was used. Results Participating family members highlighted the complementary roles and practices of ICU nurses and physicians in building therapeutic alliance. They reported how both provider groups had profession specific and shared contributions to foster family communication, integration, and collaboration, while physicians played a key role in family empowerment. Families’ lack of familiarity with ICU personnel and processes, physicians’ sporadic availability and use of medical jargon during rounds, however, reinforced long established power differences between lay families and expert physicians and challenged family integration. Family members also identified informal interactions as missed opportunities for relationship-building with physicians. While informal interactions with nurses at the bedside facilitated therapeutic alliance, inconsistent and ad-hoc interactions related to routine decision-making hindered family empowerment. Conclusions Multiple opportunities exist to improve family-provider relationships in the ICU. The four dimensions of therapeutic alliance prove analytically useful to highlight those aspects that work well and need improvement, such as in the areas of family integration and empowerment. Electronic supplementary material The online version of this article (10.1186/s12913-018-3341-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Csilla Kalocsai
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. .,Patient/Client and Family Education, Centre for Mental Health and Addiction, 33 Russell Street, Toronto, Ontario, M5S 3M1, Canada.
| | - Andre Amaral
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dominique Piquette
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Grace Walter
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Shelly P Dev
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Taylor
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - James Downar
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Palliative Medicine, University of Toronto, Toronto, Canada
| | - Lesley Gotlib Conn
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
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Tolotti A, Bagnasco A, Catania G, Aleo G, Pagnucci N, Cadorin L, Zanini M, Rocco G, Stievano A, Carnevale FA, Sasso L. The communication experience of tracheostomy patients with nurses in the intensive care unit: A phenomenological study. Intensive Crit Care Nurs 2018; 46:24-31. [PMID: 29709466 DOI: 10.1016/j.iccn.2018.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/20/2017] [Accepted: 01/04/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the experience and sources of comfort and discomfort in tracheostomy patients, when they communicate with nurses in the Intensive Care Unit. RESEARCH METHODOLOGY/DESIGN Benner's interpretive phenomenology. Data were collected through: a) semi-structured interviews conducted with the patients after leaving the intensive care unit; b) participant observation; c) situated interviews with intensive care nurses. SETTING The intensive care unit of a hospital in Northern Italy. FINDINGS Eight patients and seven nurses were included in this study. Two main themes were identified 1) feeling powerless and frustrated due to the impossibility to use voice to communicate; 2) facing continual misunderstanding, resignation, and anger during moments of difficulty and/or communication misunderstandings. The main communication discomfort factors were: struggling with not knowing what was happening, feeling like others had given up on me, living in isolation and feeling invisible. The main comfort factors were: being with family members, feeling reassured by having a call bell nearby and nurses' presence. CONCLUSIONS This study highlights the important role of communication in tracheostomy patients in intensive care and how closely it is linked to all the aspects of a person's life, which cannot be underestimated as just not being able to use one's voice.
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Affiliation(s)
- Angela Tolotti
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Nicola Pagnucci
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Lucia Cadorin
- CRO Aviano National Cancer Institute, Via F. Gallini, 2, 22081 Aviano, Italy.
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Gennaro Rocco
- Italian Nurses' National Social Security Council (ENPAPI), Via A. Farnese 3, 00192 Rome, Italy
| | - Alessandro Stievano
- Centro di Eccellenza per la Cultura e la Ricerca Infermieristica, Via G. Cesare 78, 00192 Rome, Italy
| | | | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
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Implementation of a Nurse-Led Family Meeting in a Neuroscience Intensive Care Unit. Dimens Crit Care Nurs 2018; 35:268-76. [PMID: 27487752 DOI: 10.1097/dcc.0000000000000199] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE/OBJECTIVES The aims of this study were to develop, implement, and evaluate the impact of early intensive care unit (ICU) nurse-led family meetings on nurse-family communication, family decision making, and satisfaction of family members. BACKGROUND Intensive care unit nurses are in an ideal position to meet family needs, and family members may cope better with the crisis of an ICU admission if consistent honest information is provided by nurses; however, there are no early ICU family meetings led by bedside nurses. METHODS This quality improvement project was implemented in a 10-bed neuroscience ICU over a 3-month period. A convenience sample of 23 nurses participated in the project. Following development of a communication protocol to facilitate nurse-led meetings, the nurses received education and then implemented the protocol. Thirty-one family members participated in the project. Family members were surveyed before and after the meetings. RESULTS Mean meeting time was 26 (SD, 14) minutes. Following implementation of the meetings, findings demonstrated that families felt that communication improved (P = .02 and P = .008), they had appropriate information for decision making allowing them to feel in control (P = .002), and there was an increase in family satisfaction (P = .001). CONCLUSION Early ICU nurse-led family meetings were feasible, improved communication between ICU nurses and family members, facilitated decision making in ICU families, and increased satisfaction of family members.
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Dithole KS, Thupayagale-Tshweneagae G, Akpor OA, Moleki MM. Communication skills intervention: promoting effective communication between nurses and mechanically ventilated patients. BMC Nurs 2017; 16:74. [PMID: 29270079 PMCID: PMC5732530 DOI: 10.1186/s12912-017-0268-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/24/2017] [Indexed: 02/03/2023] Open
Abstract
Background Patients in the Intensive Care Unit (ICU) often experience communication difficulties - usually associated with mechanical ventilation - resulting in psychological problems such as anxiety, fear, and depression. Good communication between nurses and patients is critical for success from personalised nursing care of each patient. The purpose of this study is to describe nurses’ experience of a communication skills training intervention. Methods A convenience sample of twenty intensive care nurses participated in the study. Data was collected by means of interviews with nurses. Data from the interviews were analysed using qualitative thematic content analysis. Results Six themes emerged: (1) acceptance of knowledge and skills developed during workshops; (2) management support; (3) appreciation of augmentative and alternative communication (AAC) devices; (4) change in attitudes; and (5) the need to share knowledge with others and (6) inclusion of communication skills workshop training as an integral part of an orientation programme for all nurses. Conclusion The findings of this study indicated that the application of augmentative and alternative communication devices and strategies can improve nurse-patient communication in intensive care units. Therefore, the implementation of communication skills training for intensive care nurses should constantly be encouraged and, indeed, introduced as a key element of ICU care training.
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Affiliation(s)
- K S Dithole
- School of Nursing, University of Botswana, Gaborone, Botswana
| | | | - Oluwaseyi A Akpor
- Department of Health Studies, University of South Africa, Pretoria, South Africa.,Department of Nursing, College of Medicine and Health Sciences, Afe Babalola University, KM 8.5 Afe Babalola Way, Ado-Ekiti, Ekiti State PMB 5454 Nigeria
| | - Mary M Moleki
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Dahlin C, Coyne P. End of Life: Reflecting on Things That Matter. Semin Oncol Nurs 2017; 33:483-488. [PMID: 29096987 DOI: 10.1016/j.soncn.2017.09.006] [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: 10/18/2022]
Abstract
OBJECTIVES To promote oncology nurse communication that is grounded on principles of ethics, individual care, and shared decision-making. DATA SOURCES Articles and references in the communication, nursing and oncology nursing literature CONCLUSION: Communication is essential to effectively advocate to meet the needs of cancer patients and their families, and other health care providers, particularly in the quality-of life domains. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are in a prime position to facilitate quality communication. Nurses need education in communication to promote quality care and navigate critical junctures in the cancer continuum.
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Mize D. The meaning of patient-nurse interaction for older women in healthcare settings: A Qualitative Descriptive Study. Int J Older People Nurs 2017; 13. [PMID: 28940960 DOI: 10.1111/opn.12167] [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: 08/29/2016] [Accepted: 08/11/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to explore the meaning of patient-nurse interaction for older women receiving care in healthcare settings. BACKGROUND Older women are often overlooked or misunderstood by the nurses caring for them. Some research exists on nurses' perception of their interaction with patients, yet few studies have described the meaning of such interaction from the patients' perspective. METHODS This was a pilot study using qualitative description as a methodology. Data were filtered through a lens of critical feminist theory to interpret interactions taking place in healthcare settings that are often characterised by paternalism. Seven women between the ages of 66 and 81 were interviewed using a semi-structured guide. RESULTS Participants had a distinctive perspective on the experience of caring. Their expressions include stories of being cared for themselves by nurses as well as historical recalls of being the one-caring for family members. In these combined stories, the contrast between the nurses who held caring in primacy and those who were distinctly uncaring sheds light on the importance of cultivating a moral ideal of caring and respect for personhood. CONCLUSION A population of older women who potentially face disabling conditions must rely on direct, meaningful, interaction with nurses to successfully navigate the healthcare system. The findings suggest that these women did not have consistent access to such interaction. IMPLICATIONS FOR PRACTICE The gathering and interpretation of new narratives about patient-nurse interaction for older women could lead to a deeper understanding of power and civility as it impacts a caring relationship. Further research using a theoretical lens of critical feminism has implications for improving healthcare delivery for older women worldwide.
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Affiliation(s)
- Darcy Mize
- School of Nursing, Oregon Health and Science University, Klamath Falls, OR, USA
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Rojas Silva N, Padilla Fortunatti C, Molina Muñoz Y, Amthauer Rojas M. The needs of the relatives in the adult intensive care unit: Cultural adaptation and psychometric properties of the Chilean-Spanish version of the Critical Care Family Needs Inventory. Intensive Crit Care Nurs 2017; 43:123-128. [PMID: 28917604 DOI: 10.1016/j.iccn.2017.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/25/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The admission of a patient to an intensive care unit is an extraordinary event for their family. Although the Critical Care Family Needs Inventory is the most commonly used questionnaire for understanding the needs of relatives of critically ill patients, no Spanish-language version is available. The aim of this study was to culturally adapt and validate theCritical Care Family Needs Inventory in a sample of Chilean relatives of intensive care patients. METHODS The back-translated version of the inventory was culturally adapted following input from 12 intensive care and family experts. Then, it was evaluated by 10 relatives of recently transferred ICU patients and pre-tested in 10 relatives of patients that were in the intensive care unit. Psychometric properties were assessed through exploratory factor analysis and Cronbach's α in a sample of 251 relatives of critically ill patients. RESULTS The Chilean-Spanish version of the Critical Care Family Needs Inventoryhad minimal semantic modifications and no items were deleted. A two factor solution explained the 31% of the total instrument variance. Reliability of the scale was good (α=0.93), as were both factors (α=0.87; α=0.93). CONCLUSION The Chilean-Spanish version of theCritical Care Family Needs Inventory was found valid and reliable for understanding the needs of relatives of patients in acute care settings.
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Affiliation(s)
- Noelia Rojas Silva
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Cristobal Padilla Fortunatti
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile; Unidad de Paciente Critico, Hospital Clinico UC CHRISTUS, Santiago, Chile
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Jakimowicz S, Perry L, Lewis J. An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit. J Clin Nurs 2017; 26:4153-4171. [PMID: 28699268 DOI: 10.1111/jocn.13957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To systematically review the literature describing factors perceived by nurses as impacting the provision of patient-centred nursing in the intensive care unit. BACKGROUND Patient-centred nursing in critical care differs from other healthcare areas, and the aggressive curative environment of the ICU has potential to compromise some of its elements. Understanding critical care, nurses' perceptions of promoting and deterrent factors may inform development of strategies to support effective patient-centred nursing and job satisfaction in this workforce. DESIGN An integrative literature review. REVIEW METHOD Whittemore and Knafl's method was used with "best-fit" framework synthesis. CINAHL, PsycINFO, Medline and EMBASE were searched for 2000-2016 literature using search terms drawn from the ICU patient-centred framework. RESULTS In total, 3,079 papers were identified, with 23 retained after applying eligibility criteria. Five themes were identified: Nurse identity; Organisation; Communication; Relationships; and Ideology of ICU. Almost every theme and related categories referred to factors acting as barriers to patient-centred nursing in the ICU; only four referred to supports/facilitators. Findings showed that provision of patient-centred nursing may be compromised by some factors of the critical care environment, and illustrate the challenges and complexity of providing effective patient-centred nursing in this environment. CONCLUSION Findings should be applied to address barriers and to enhance facilitators of effective patient-centred nursing in critical care. The emotional and physical demands of critical care nursing are major considerations; supporting these nurses to fulfil their challenging role may empower them in their professional quality of life and provide a basis for workforce retention as well as delivery of effective patient-centred nursing. RELEVANCE TO CLINICAL PRACTICE Measures to enhance patient-centred nursing could promote critical care nurses' job satisfaction and workforce retention, and be applied more broadly and collaboratively to promote multidisciplinary patient-centred care.
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Affiliation(s)
| | - Lin Perry
- Department of Nursing Research & Practice Development, Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Joanne Lewis
- Faculty of Health, University of Technology, Sydney, NSW, Australia
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Song HS, Choi J, Son YJ. The relationship between professional communication competences and nursing performance of critical care nurses in South Korea. Int J Nurs Pract 2017; 23. [PMID: 28752656 DOI: 10.1111/ijn.12576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/15/2017] [Accepted: 06/16/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ineffective communication of critical care nurses can lead to higher levels of burnout and negatively affect quality of patient care and patient outcomes such as higher mortality. AIM The purpose of this study is to describe the relationship between professional communication competences and nursing performance of critical care nurses in South Korea. METHOD This cross-sectional study collected data on 197 intensive care unit staff nurses in 3 tertiary academic medical centres in South Korea from July to November 2014. RESULTS In the hierarchical regression analysis, the professional communication competences were the only significant predictors of nursing performance after adjusting for sociodemographic characteristics. In addition, the greater professional communication competences of nurses were associated with being older and having a higher education level, more years of overall clinical and intensive care unit experience, and a higher monthly salary. CONCLUSION Our findings indicate that communication skills-related training should be included in the practical education to improve nursing performance for the quality of intensive care. Further research is needed to identify the comprehensive factors on professional communication competences of nurses in intensive care units.
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Affiliation(s)
- Hyo-Suk Song
- Department of Nursing, Wonkwang University, Iksan, South Korea
| | - JiYeon Choi
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Koszalinski RS, Tappen RM, Hickman C, Melhuish T. Communication Needs of Critical Care Patients Who Are Voiceless. Comput Inform Nurs 2017; 34:339-44. [PMID: 27315366 DOI: 10.1097/cin.0000000000000266] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Voice is crucial for communication in all healthcare settings. Evidence-based care highlights the need for clear communication. Clear communication methods must be applied when caring for special populations in order to assess pain effectively. Communication efforts also should be offered to patients who are in end-of-life care and would like to make independent decisions. A computer communication application was offered to patients in intensive care/critical care units in three hospitals in South Florida. Inclusion criteria included the age of 18 years or older, Richmond Agitation Sedation Scale between -1 and +1, ability to read and write English, and willingness to use the computer application. Exclusion criteria included inability to read and write English, agitation as defined by the Richmond Agitation Sedation Scale, and any patient on infection isolation protocol. Four qualitative themes were revealed, which directly relate to two published evidence-based guidelines. These are the End of Life Care and Decision Making Evidence-Based Care Guidelines and the Pain Assessment in Special Populations Guidelines. This knowledge is important for developing effective patient-healthcare provider communication.
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Affiliation(s)
- Rebecca S Koszalinski
- Author Affiliations: College of Nursing, University of Tennessee Knoxville (Dr Koszalinski); Florida Atlantic University, Boca Raton (Dr Tappen); Boca Raton Regional Hospital, Florida (Ms Hickman); and CVICU, CCU, and NSICU, Holy Cross Hospital, Fort Lauderdale, Florida (Ms Melhuish).The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article
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A Qualitative Study of Sleep-Wake Disturbance Among Veterans With Post-Acute Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2017; 31:126-35. [PMID: 26959666 DOI: 10.1097/htr.0000000000000216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Examine sleep-wake disturbance (SWD) characteristics, factors, consequences, and management strategies from the perspective of veterans with chronic stage, moderate/severe traumatic brain injury (TBI). SETTING VA Medical Center, Rocky Mountain. US PARTICIPANTS Nineteen male veterans with post-acute TBI and SWD in the VA Health Administration. DESIGN Qualitative descriptive. MEASURES Semistructured interviews, Ohio State University TBI-Identification Method, Insomnia Severity Index. RESULTS Two main dimensions emerged: "Messed up sleep" and Surviving and Managing SWD. Sleep-wake disturbance has long-term multidimensional features, etiology, consequences, and practice implications. Although SWD may not be consistently discussed with providers, the problem appears to be pervasive in many aspects of the lives of the informants. Difficulty falling asleep, frequent awakenings, and poor sleep quality were common symptoms that were described as intrusive, isolating, and difficult to self-manage. Veterans discussed a host of physical symptoms, mental health issues, environmental, and behavioral factors that contributed to SWD. Medications, sleep apnea treatment, and self-imposed isolation were frequent management strategies. Veterans expressed a willingness to try new approaches and work with providers. CONCLUSION Sleep-wake disturbance among veterans with chronic stage TBI is a multidimensional phenomenon with interplay between comorbidities, contributing factors, effects on functioning, and sleep management strategies. Implications for practice include early and routine evaluation, monitoring, and treatment of SWD. Research is needed to test interventions that address SWD and common TBI comorbidities.
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Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expect 2016; 19:1183-1202. [PMID: 27878937 PMCID: PMC5139045 DOI: 10.1111/hex.12402] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite international bodies calling for increased patient and family involvement, these concepts remain poorly defined within literature on critical and intensive care settings. OBJECTIVE This scoping review investigates the extent and range of literature on patient and family involvement in critical and intensive care settings. Methodological and empirical gaps are identified, and a future agenda for research into optimizing patient and family involvement is outlined. METHODS Searches of MEDLINE, CINAHL, Social Work Abstracts and PsycINFO were conducted. English-language articles published between 2003 and 2014 were retrieved. Articles were included if the studies were undertaken in an intensive care or critical care setting, addressed the topic of patient and family involvement, included a sample of adult critical care patients, their families and/or critical care providers. Two reviewers extracted and charted data and analysed findings using qualitative content analysis. FINDINGS A total of 892 articles were screened, 124 were eligible for analysis, including 61 quantitative, 61 qualitative and 2 mixed-methods studies. There was a significant gap in research on patient involvement in the intensive care unit. The analysis identified five different components of family and patient involvement: (i) presence, (ii) having needs met/being supported, (iii) communication, (iv) decision making and (v) contributing to care. CONCLUSION Three research gaps were identified that require addressing: (i) the scope, extent and nature of patient involvement in intensive care settings; (ii) the broader socio-cultural processes that shape patient and family involvement; and (iii) the bidirectional implications between patient/family involvement and interprofessional teamwork.
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Affiliation(s)
- Michelle Olding
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | - Sarah E. McMillan
- Collaborative Academic PracticeUniversity Health NetworkTorontoONCanada
| | - Scott Reeves
- Centre for Health and Social Care ResearchKingston University and St. George's University of LondonLondonUK
| | | | | | - Simon Kitto
- Department of Innovation in Medical EducationFaculty of MedicineUniversity of OttawaOttawaONCanada
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