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Lehmkuhl L, Munck MS, Rothmann MJ, Sorknaes AD. Exploring critically ill patients' and their relatives' experiences of intensive care unit during COVID-19: A qualitative study. Nurs Crit Care 2024; 29:427-437. [PMID: 38183390 DOI: 10.1111/nicc.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Admission to an intensive care unit has physiological and psychological consequences for patients and families, including the family's fear that the patient might die. The COVID-19 pandemic underlined this and furthermore involved visiting restrictions separating patients and families. AIM To explore how patients with confirmed COVID-19 and their relatives experienced an intensive care unit stay and its significance for family dynamics. STUDY DESIGN A qualitative study was performed during the spring of 2020. Five dyadic interviews were conducted with COVID-19 patients admitted to an intensive care unit and their relatives. The analysis was inspired by Hochman's dyadic analysis. FINDINGS The analysis revealed three themes: (1) From ill to critically ill: The trauma of separation and fear of losing loved ones; (2) The relatives' significant role in creating a shared coherent understanding of the admission in ICU due to COVID-19; (3) The nurses' roles as a go-between in maintenance of the family dynamic. CONCLUSION Separation challenged family function and destabilized family dynamics. Nurses provided emotional support, information about and contact with the patient and relatives. The patients' distorted perception of reality and lack of memory were reconstructed in new family narratives, which offered relief and stabilization of family dynamics. The nurses entered into a triad with the patient and relatives, which also contributed to maintaining a relational dynamic in the family. RELEVANCE TO CLINICAL PRACTICE Maintaining communication between health professionals, relatives and patients, and usage of virtual visits during intensive care unit stay can support the family relationship. Nurse therapeutic conversations might help families' in redefining their family dynamics after ICU admission.
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Affiliation(s)
- Lene Lehmkuhl
- Department of Anesthesiology and Intensive Care Medicine, OUH Svendborg Hospital, Svendborg, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Maja Stensdal Munck
- Department of Anesthesiology and Intensive Care Medicine, OUH Svendborg Hospital, Svendborg, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense C, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense C, Denmark
| | - Anne Dichmann Sorknaes
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Internal Medicine & Emergency Department M/FAM, OUH Svendborg Hospital, Svendborg, Denmark
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Cardoso AF, Pires MG, Cioga E, Abalroado I, Santos D, Duque FM, Loureiro R, Felizardo H, Fernandes AM, Silva R, Ventura F, Santana E, Cardoso D, Loureiro L. Experiences with remote communication in adult intensive care units during the COVID-19 pandemic: a systematic review protocol. JBI Evid Synth 2023; 21:2455-2464. [PMID: 37711062 DOI: 10.11124/jbies-23-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE The objective of this review is to explore the lived experiences of critically ill adults, their families, or health care professionals with remote communication in intensive care units (ICUs) during the COVID-19 pandemic. INTRODUCTION Family visiting restrictions in ICUs during the COVID-19 pandemic imposed significant challenges to communication between critically ill adults, their families, and the health care team. Evidence shows that several communication strategies were developed and implemented in ICUs during the COVID-19 pandemic to promote family engagement; however, the experiences of critically ill adults, their families, and health care professionals with these strategies are scattered across primary qualitative studies. INCLUSION CRITERIA This review will consider qualitative studies that include critically ill adults, their families, or health care professionals, focusing on their experiences with remote communication strategies in ICUs during the COVID-19 pandemic. METHODS This review will be conducted in accordance with JBI methodology. The search strategy will aim to locate both published and unpublished qualitative studies in English, Spanish, and Portuguese. Studies published after January 2020 will be included. Study selection, critical appraisal, and data extraction will be performed independently by 2 reviewers. Data will be presented in narrative format and synthesized using the JBI meta-aggregation process. A ConQual Summary of Findings will be presented. REVIEW REGISTRATION PROSPERO CRD42022383603.
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Affiliation(s)
- Ana Filipa Cardoso
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Miguel Grilo Pires
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Elisabete Cioga
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Inês Abalroado
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Diana Santos
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Filipa Margarida Duque
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Ricardo Loureiro
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Helena Felizardo
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - António Manuel Fernandes
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rosa Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
- Nursing School of Porto (ESEP), Porto, Portugal
| | - Filipa Ventura
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Elaine Santana
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Daniela Cardoso
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Luís Loureiro
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
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Conte H, Dorell Å, Wedin E, Eckerblad J. In their absence; intensive care nurses' experiences of communicating and supporting relatives from a distance. BMC Nurs 2023; 22:421. [PMID: 37950204 PMCID: PMC10636861 DOI: 10.1186/s12912-023-01559-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Having a critically ill family member in the intensive care unit (ICU) is a challenging situation and ICU nurses play an important part in supporting relatives to make sense of the situation. Strict visiting policies inhibited the family's presence in ICUs during 2020-22, and the communication between nurses and families changed drastically. Information and support are at the core of the ICU nurses' profession, and the pandemic backdrop created a split between what intensive care nurses have a professional responsibility to perform and which actions were possible. To get a fuller picture, the aim of this study was: To describe intensive care nurses' experiences of communicating and supporting relatives from a distance while working during visiting restrictions. METHOD A qualitative descriptive design using individual and semi-structured interviews with 16 ICU nurses. The interviews were analyzed using inductive thematic analysis. This study followed the consolidated criteria for reporting qualitative research (COREQ). RESULTS Due to the visiting restriction during the COVID-19 pandemic, ICU nurses found themselves in a situation where proximity and time to develop an interpersonal connection with relatives disappeared overnight. The nurses' experiences of communicating with and supporting families is described in three themes: "Finding ways to create order out of chaos"; "Guiding the relatives to a fuller picture of the situation"; and "Feeling insufficient in their support". CONCLUSION Visiting restrictions in the ICU meant that ICU nurses missed vital information about their patients as a person, which might have had a negative effect on personalizing and centring the patient care. But using a combination of digital and audio tools helped nurses to guide the relatives to a clearer picture of the situation as a whole. The support that nurses were able to provide to relatives was often insufficient due to the visiting restriction and as a consequence, they experienced physical and psychological stress.
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Affiliation(s)
- Helen Conte
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Stockholm, SE-141 83, Sweden
| | - Åsa Dorell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Stockholm, SE-141 83, Sweden
| | - Emilia Wedin
- Intesive Care Unit, Örnsköldsvik Hospital, Örnsköldsvik, 89189, Sweden
| | - Jeanette Eckerblad
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Stockholm, SE-141 83, Sweden.
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Varghese MP, Selwyn T, Nair S, Samuel S, Chacko B, Pichamuthu K. Assessment of Family Satisfaction with Remote Communication for Critically Ill COVID-19 Patients: An Observational Cohort Study. Indian J Crit Care Med 2023; 27:537-544. [PMID: 37636852 PMCID: PMC10452773 DOI: 10.5005/jp-journals-10071-24504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023] Open
Abstract
Background During the pandemic, traditional family meetings were replaced by remote telecommunications. We assessed the families' satisfaction with these communications using a survey-based questionnaire. Methods The study involved 20-minute telephonic surveys conducted with the family member who was updated during the hospitalization of the patient. A thematic-based questionnaire with responses on a scale of 5 ranging from very dissatisfied to very satisfied was used. The responses were dichotomized into bad and good reports for analysis. Results A total of 196 patients were eligible. Only 154 patients' family representatives consented to the study. The frequency and content of the telephonic updates were satisfactory. The bad report was assigned to 5% of families only. Among features assessing empathy of communication providers, the satisfaction rate was much higher with 3% of families alone providing a bad report. The response was significantly biased against the final outcome of the patient with poor review often provided by relatives of patients who had succumbed to the illness. The dissatisfaction rate was much higher, above 12% for the trust of communication and ICU visitation. However, the final outcome of the patient did not affect the trust in the information conveyed by the physician. Interpretation This study highlights several drawbacks in the communication strategy during the second surge of coronavirus disease-2019 (COVID-19). The final outcome of the patient was the key decisive factor for the response to most of the questionnaire. Sustained faith in communication by the physician despite the final outcome of the patient, re-emphasizes the need for emotional connection and training for breaking bad news. How to cite this article Varghese MP, Selwyn T, Nair S, Samuel S, Chacko B, Pichamuthu K. Assessment of Family Satisfaction with Remote Communication for Critically Ill COVID-19 Patients: An Observational Cohort Study. Indian J Crit Care Med 2023;27(8):537-544.
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Affiliation(s)
- Mammen Philip Varghese
- Department of Neuro Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tryphena Selwyn
- Department of Neuro Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shalini Nair
- Department of Neuro Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shobha Samuel
- Department of Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Binila Chacko
- Department of Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kishore Pichamuthu
- Department of Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
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Ponnapa Reddy MR, Kadam U, Lee JDY, Chua C, Wang W, McPhail T, Lee J, Yarwood N, Majumdar M, Subramaniam A. Family satisfaction with intensive care unit communication during the COVID-19 pandemic: a prospective multicentre Australian study Family Satisfaction - COVID ICU. Intern Med J 2022; 53:481-491. [PMID: 36346289 PMCID: PMC9877714 DOI: 10.1111/imj.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Virtual communication has become common practice during the coronavirus disease 2019 (COVID-19) pandemic because of visitation restrictions. AIMS The authors aimed to evaluate overall family satisfaction with the intensive care unit (FS-ICU) care involving virtual communication strategies during the COVID-19 pandemic period. METHODS In this prospective multicentre study involving three metropolitan hospitals in Melbourne, Australia, the next of kin (NOK) of all eligible ICU patients between 1 July 2020 and 31 October 2020 were requested to complete an adapted version of the FS-ICU 24-questionnaire. Group comparisons were analysed and calculated for family satisfaction scores: ICU/care (satisfaction with care), FS-ICU/dm (satisfaction with information/decision-making) and FS-ICU/total (overall satisfaction with the ICU). The essential predictors that influence family satisfaction were identified using quantitative and qualitative analyses. RESULTS Seventy-three of the 227 patients' NOK who initially agreed completed the FS-ICU questionnaire (response rate 32.2%). The mean FS-ICU/total was 63.9 (standard deviation [SD], 30.8). The mean score for satisfaction with FS-ICU/dm was lower than the FS-ICU/care (62.1 [SD, 30.3) vs 65.4 (SD, 31.4); P < 0.001]. There was no difference in mean FS-ICU/total scores between survivors (n = 65; 89%) and non-survivors (n = 8, 11%). Higher patient Acute Physiology and Chronic Health Evaluation III score, female NOK and the patient dying in the ICU were independent predictors for FS-ICU/total score, while a telephone call at least once a day by an ICU doctor was related to family satisfaction for FS-ICU/dm. CONCLUSIONS There was low overall family satisfaction with ICU care and virtual communication strategies adopted during the COVID-19 pandemic. Efforts should be targeted for improving factors with virtual communication that cause low family satisfaction during the COVID-19 pandemic.
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Affiliation(s)
- Mallikarjuna Reddy Ponnapa Reddy
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia,Department of Intensive Care MedicineCalvary Public HospitalBruceAustralian Capital TerritoryAustralia
| | - Umesh Kadam
- Department of Intensive Care MedicineWerribee Mercy HospitalWerribeeVictoriaAustralia,Department of Intensive Care MedicineMonash Health Casey HospitalBerwickVictoriaAustralia,Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia
| | - John Dong Young Lee
- Department of Intensive Care MedicineMonash Health Casey HospitalBerwickVictoriaAustralia
| | - Clara Chua
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Wei Wang
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Tomecka McPhail
- Department of Social WorkWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Jodie Lee
- Department of Social WorkMonash Health Casey HospitalBerwickVictoriaAustralia
| | - Naomi Yarwood
- Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia
| | - Mainak Majumdar
- Department of Intensive Care MedicineWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Ashwin Subramaniam
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia,Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Peninsula Clinical SchoolMonash UniversityFrankstonVictoriaAustralia
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