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Dimopoulos S, Leggett NE, Deane AM, Haines KJ, Abdelhamid YA. Models of intensive care unit follow-up care and feasibility of intervention delivery: A systematic review. Aust Crit Care 2024; 37:508-516. [PMID: 37263902 DOI: 10.1016/j.aucc.2023.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The optimal model of outpatient intensive care unit (ICU) follow-up care remains uncertain, and there is limited evidence of benefit. RESEARCH QUESTION The objective of this research is to describe existing models of outpatient ICU follow-up care, quantify participant recruitment and retention, and describe facilitators of patient engagement. STUDY DESIGN & METHODS A systematic search of the MEDLINE and EMBASE databases was undertaken in June 2021. Two independent reviewers screened titles, abstracts, and full texts against eligibility criteria. Studies of adults with any outpatient ICU follow-up were included. Studies were excluded if published before 1990, not published in English, or of paediatric patients. Quantitative data were extracted using predefined data fields. Key themes were extracted from qualitative studies. Risk of bias was assessed. RESULTS A total of 531 studies were screened. Forty-seven studies (32 quantitative and 15 qualitative studies) with a total of 5998 participants were included. Of 33 quantitative study interventions, the most frequently reported model of care was in-person hospital-based interventions (n = 27), with 10 hybrid (part in-hospital, part remote) interventions. Literature was limited for interventions without hospital attendance (n = 6), including telehealth and diaries. The median ranges of rates of recruitment, rates of intervention delivery, and retention to outcome assessment for hospital-based interventions were 51.5% [24-94%], 61.9% [8-100%], and 52% [8.1-82%], respectively. Rates were higher for interventions without hospital attendance: 82.6% [60-100%], 68.5% [59-89%], and 75% [54-100%]. Facilitators of engagement included patient-perceived value of follow-up, continuity of care, intervention accessibility and flexibility, and follow-up design. Studies had a moderate risk of bias. INTERPRETATION Models of post-ICU care without in-person attendance at the index hospital potentially have higher rates of recruitment, intervention delivery success, and increased participant retention when compared to hospital-based interventions. PROSPERO REGISTRATION CRD42021260279.
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Affiliation(s)
| | - Nina E Leggett
- Department of Physiotherapy, Western Health, Victoria, Australia; Department of Critical Care, School of Medicine, The University of Melbourne, Victoria, Australia
| | - Adam M Deane
- Intensive Care Unit, The Royal Melbourne Hospital, Victoria, Australia; Department of Critical Care, School of Medicine, The University of Melbourne, Victoria, Australia
| | - Kimberley J Haines
- Department of Physiotherapy, Western Health, Victoria, Australia; Department of Critical Care, School of Medicine, The University of Melbourne, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Intensive Care Unit, The Royal Melbourne Hospital, Victoria, Australia; Department of Critical Care, School of Medicine, The University of Melbourne, Victoria, Australia.
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Leggett N, Emery K, Rollinson TC, Deane AM, French C, Manski-Nankervis JA, Eastwood G, Miles B, Witherspoon S, Stewart J, Merolli M, Ali Abdelhamid Y, Haines KJ. Clinician- and Patient-Identified Solutions to Reduce the Fragmentation of Post-ICU Care in Australia. Chest 2024:S0012-3692(24)00247-2. [PMID: 38382876 DOI: 10.1016/j.chest.2024.02.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Critical care survivors experience multiple care transitions, with no formal follow-up care pathway. RESEARCH QUESTION What are the potential solutions to improve the communication between treating teams and integration of care following an ICU admission, from the perspective of patients, their caregivers, intensivists, and general practitioners (GPs) from diverse socioeconomic areas? STUDY DESIGN AND METHODS This study included a qualitative design using semi-structured interviews with intensivists, GPs, and patients and caregivers. Framework analysis was used to analyze data and to identify solutions to improve the integration of care following hospital discharge. Patients were previously mechanically ventilated for > 24 h in the ICU and had access to a video-enabled device. Clinicians were recruited from hospital networks and a state-wide GP network. RESULTS Forty-six interviews with clinicians, patients, and caregivers were completed (15 intensivists, 8 GPs, 15 patients, and 8 caregivers). Three higher level feedback loops were identified that comprised 10 themes. Feedback loop 1 was an ICU and primary care collaboration. It included the following: (1) developing collaborative relationships between the ICU and primary care; (2) providing interprofessional education and resources to support primary care; and (3) improving role clarity for patient follow-up care. Feedback loop 2 was developing mechanisms for improved communication across the care continuum. It included: (4) timely, concise information-sharing with primary care on post-ICU recovery; (5) survivorship-focused information-sharing across the continuum of care; (6) empowering patients and caregivers in self-management; and (7) creation of a care coordinator role for survivors. Feedback loop 3 was learning from post-ICU outcomes to improve future care. It included: (8) developing comprehensive post-ICU care pathways; (9) enhancing support for patients following a hospital stay; and (10) integration of post-ICU outcomes within the ICU to improve clinician morale and understanding. INTERPRETATION Practical solutions to enhance the quality of survivorship for critical care survivors and their caregivers were identified. These themes are mapped to a novel conceptual model that includes key feedback loops for health system improvements and foci for future interventional trials to improve ICU survivorship outcomes.
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Affiliation(s)
- Nina Leggett
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia; Department of Critical Care, the University of Melbourne, Melbourne, VIC, Australia.
| | - Kate Emery
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Thomas C Rollinson
- Department of Physiotherapy, the University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Adam M Deane
- Department of Intensive Care, Melbourne Health, Melbourne, VIC, Australia; Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Glenn Eastwood
- Department of Critical Care, Austin Health, Melbourne, VIC, Australia
| | - Briannah Miles
- Department of Intensive Care, Melbourne Health, Melbourne, VIC, Australia
| | | | - Jonathan Stewart
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Mark Merolli
- Centre for Digital Transformation of Health, the University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, the University of Melbourne, Melbourne, VIC, Australia
| | - Yasmine Ali Abdelhamid
- Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia; Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia
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Raios C, Keating JL, Skinner EH, Opdam HI, Haines KJ. Exploring current physiotherapy practices in the care of people who are potential lung donors: A qualitative study. Aust Crit Care 2024:S1036-7314(24)00001-8. [PMID: 38365522 DOI: 10.1016/j.aucc.2023.12.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/19/2023] [Accepted: 12/16/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE The aim of this study was to determine physiotherapists' current practices and perspectives regarding their role in caring for people who are potential lung donors in the intensive care unit (ICU). METHODS A qualitative descriptive design was used. Qualitative data were collected through audio-recorded, semistructured focus groups with a purposive sample of physiotherapists with experience working with people who are potential lung donors in ICUs. Two investigators completed independent thematic analysis to identify themes. RESULTS Seven focus groups were completed with 27 physiotherapists at six metropolitan health services in Victoria, Australia. Six key themes were identified: (i) physiotherapists' involvement in care was highly variable; (ii) physiotherapists were not aware of existing evidence or guidelines for the care of people who are potential donors and followed usual practices; (iii) a consistent vision of the physiotherapy role was lacking; (iv) physiotherapists' engagement with the team routinely involved in care of people who are potential donors varied considerably; (v) physiotherapists faced practice challenges associated with delivering care to potential donors; and (vi) several enablers could support a role for physiotherapy in this patient population. CONCLUSIONS Variability in physiotherapy practice is associated with local ICU culture, physiotherapy leadership capabilities, knowledge, and experience. The spectrum of practice ranged from physiotherapists being highly engaged to being completely uninvolved. Physiotherapists held mixed perspectives regarding whether physiotherapists should have a role in managing people who are potential lung donors. It would benefit the profession to develop consensus and standardisation of the role of physiotherapists in caring for these patients. TWEETABLE ABSTRACT Variability in views and practices amongst physiotherapists who provide care to patients who are potential lung donors in the ICU.
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Affiliation(s)
- Cassandra Raios
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia; Department of Physiotherapy, Western Health, Footscray 3011, Victoria, Australia.
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia; Department of Physiotherapy, Western Health, Footscray 3011, Victoria, Australia; Department of General Medicine, Alfred Health, Melbourne 3004, Victoria, Australia
| | - Helen I Opdam
- Organ and Tissue Authority, Canberra, ACT, Australia; Department of Intensive Care, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Kimberley J Haines
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia; Department of Physiotherapy, Western Health, Footscray 3011, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Parkville 3001, Victoria, Australia
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Haines KJ, Hibbert E, Skinner EH, Leggett N, Holdsworth C, Ali Abdelhamid Y, Bates S, Bicknell E, Booth S, Carmody J, Deane AM, Emery K, Farley KJ, French C, Krol L, MacLeod-Smith B, Maher L, Paykel M, Iwashyna TJ. In-person peer support for critical care survivors: The ICU REcovery Solutions cO-Led through surVivor Engagement (ICURESOLVE) pilot randomised controlled trial. Aust Crit Care 2024:S1036-7314(24)00022-5. [PMID: 38360469 DOI: 10.1016/j.aucc.2024.01.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Peer support is a promising intervention to mitigate post-ICU disability, however there is a paucity of rigorously designed studies. OBJECTIVES The objective of this study was to establish feasibility of an in-person, co-designed, peer-support model. METHODS Prospective, randomised, adaptive, single-centre pilot trial with blinded outcome assessment, conducted at a university-affiliated hospital in Melbourne, Australia. Intensive care unit survivors (and their nominated caregiver, where survivor and caregiver are referred to as a dyad), >18 years of age, able to speak and understand English and participate in phone surveys, were eligible. Participants were randomised to the peer-support model (six sessions, fortnightly) or usual care (no follow-up or targeted information). Two sequential models were piloted: 1. Early (2-3 weeks post hospital discharge) 2. Later (4-6 weeks post hospital discharge). Primary outcome was feasibility of implementation measured by recruitment, intervention attendance, and outcome completion. Secondary outcomes included post-traumatic stress and social support. RESULTS Of the 231 eligible patients, 80 participants were recruited. In the early model we recruited 38 participants (28 patients, 10 carers; 18 singles, 10 dyads), with an average (standard deviation) age of 60 (18) years; 55 % were female. Twenty-two participants (58 %) were randomised to intervention. Participants in the early intervention model attended a median (interquartile range) of 0 (0-1) sessions (total 24 sessions), with 53% (n = 20) completing the main secondary outcome of interest (Impact of Event Scale) at the baseline and 37 % (n = 14) at the follow-up. For the later model we recruited 42 participants (32 patients, 10 carers; 22 singles, 10 dyads), with an average (standard deviation) age of 60.4 (15.4) years; 50 % were female. Twenty-one participants (50 %) were randomised to intervention. The later intervention model attended a median (interquartile range) of 1 (0-5) sessions (total: 44 sessions), with the main secondary outcome impact of events scale (IES-R) completed by 41 (98 %) participants at baseline and 29 (69 %) at follow-up. CONCLUSIONS In this pilot trial, a peer-support model that required in-person attendance delivered in a later posthospital phase of recovery appeared more feasible than an early model. Further research should investigate alternative modes of intervention delivery to improve feasibility (ACTRN12621000737831).
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia.
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | | | - Nina Leggett
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Department of Intensive Care, Melbourne Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Samantha Bates
- Department of Intensive Care, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Erin Bicknell
- Department of Physiotherapy, Melbourne Health, Melbourne, Australia
| | - Sarah Booth
- Department of Social Work, Western Health, Melbourne, Australia
| | - Jacki Carmody
- Department of Psychology, Western Health, Melbourne, Australia
| | - Adam M Deane
- Department of Intensive Care, Melbourne Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Kate Emery
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - K J Farley
- Department of Intensive Care, Western Health, Melbourne, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Lauren Krol
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | | | - Lynne Maher
- Ko Awatea, Health System Innovation and Improvement, Counties Manukau Health, Auckland, New Zealand
| | - Melanie Paykel
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Theodore J Iwashyna
- Pulmonary and Critical Care Medicine, School of Medicine, John Hopkins University, Baltimore, MD, United States
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Haines KJ, Ferrante LE. Prediction of Post-ICU Impairments-Is It Possible? Crit Care Med 2024; 52:337-340. [PMID: 38240513 DOI: 10.1097/ccm.0000000000006082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
- Department of Critical Care, School of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, & Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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Holton S, Rasmussen B, Crowe S, Trueman M, Dabscheck A, Booth S, Hitch D, Said CM, Haines KJ, Wynter K. Worsening psychological wellbeing of Australian hospital clinical staff during three waves of the coronavirus (COVID-19) pandemic. AUST HEALTH REV 2023; 47:641-651. [PMID: 37844618 DOI: 10.1071/ah23120] [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] [Received: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
Objective This study aimed to assess and compare the psychological wellbeing of Australian hospital clinical staff at three timepoints during the coronavirus disease 2019 (COVID-19) pandemic. Methods An anonymous, online, cross-sectional survey was conducted at three timepoints during the COVID-19 pandemic (T1: May-June 2020; T2: October-December 2020; T3: November 2021-January 2022). The surveys were completed by nurses, midwives, doctors and allied health staff employed at a large metropolitan tertiary health service located in Melbourne, Australia. The Depression, Anxiety and Stress Scale (DASS-21) assessed respondents' psychological wellbeing in the past week. General linear models were used to measure the effects of survey timepoint on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics. Results A total of 1470 hospital clinical staff completed at least one survey (T1: 668 (14.7%), T2: 358 (7.9%) and T3: 444 (9.8%)). Respondents' sociodemographic characteristics were similar across the three timepoints and within professional discipline groups. Respondents' psychological wellbeing was worse at T3 compared to the earlier survey timepoints. Adjusting for respondent characteristics, depression, anxiety and stress scores were significantly higher for respondents of the third survey compared to the first (P < 0.001). Conclusions There was a significant and persistent negative impact on the psychological wellbeing of hospital clinical staff in Australia across waves of the COVID-19 pandemic. Hospital clinical staff would benefit from ongoing and continued wellbeing support during and after pandemic waves.
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Affiliation(s)
- Sara Holton
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research in the Institute of Health Transformation - Western Health Partnership, Deakin University, St Albans, Vic. 3021, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research in the Institute of Health Transformation - Western Health Partnership, Deakin University, St Albans, Vic. 3021, Australia; and Public Health, Copenhagen, Denmark; and Faculty of Health Services, University of Southern Denmark, Odense M, Denmark
| | - Shane Crowe
- Nursing and Midwifery, Western Health, St Albans, Vic. 3021, Australia
| | - Melody Trueman
- Nursing and Midwifery, Western Health, St Albans, Vic. 3021, Australia
| | - Adrian Dabscheck
- Medical Services, Western Health, Footscray, Vic. 3011, Australia
| | - Sarah Booth
- Allied Health, Western Health, St Albans, Vic. 3021, Australia
| | - Danielle Hitch
- Allied Health, Western Health, St Albans, Vic. 3021, Australia; and Occupational Science and Therapy, Deakin University, Geelong, Vic. 3220, Australia
| | - Catherine M Said
- Allied Health, Western Health, St Albans, Vic. 3021, Australia; and Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Vic. 3010, Australia; and Australian Institute of Musculoskeletal Science, St. Albans, Vic. 3021, Australia
| | | | - Karen Wynter
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research in the Institute of Health Transformation - Western Health Partnership, Deakin University, St Albans, Vic. 3021, Australia
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Witherspoon SA, Plowman SAJ, Power PZ, Mulvey A, Haines KJ, Maiden MJ. Low prevalence of communication between intensive care unit medical staff and general practitioners: A single-centre retrospective study. Aust Crit Care 2023; 36:1090-1094. [PMID: 37055244 DOI: 10.1016/j.aucc.2023.03.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND General practitioners (GPs) have a central role in delivering care to the Australian community, which includes coordinating management of chronic diseases and treatment of patients after admission to intensive care units (ICUs). Consultations between ICUs and GPs may become increasingly relevant as patients of advancing age and chronic disease burden are admitted to ICUs. However, how frequently and for what reason such consultations occur remain unclear. OBJECTIVES The objective of this study was to determine the prevalence and themes of consultations between ICU medical staff and GPs. METHODS Ten years of electronic medical records in the ICU of a regional Australian hospital were searched for patient admissions documenting the terms "gp", "general p∗", or "primary care∗" anywhere throughout the record. The proportion of ICU admissions in which a consultation between ICU staff members and GPs was documented was recorded along with the reason/s for the consultation and designation (resident, registrar, consultant) of those who communicated with the GP. MAIN OUTCOME MEASURES Main outcome measures included the proportion of ICU admissions with a documented consultation between ICU staff and GPs, theme of the consultation, and designation (resident, registrar, consultant) of those who communicated with the GP. RESULTS Of 13 402 admissions to the ICU, 137 (1.02%) had a documented consultation between ICU medical staff and GPs. Most consultations (n = 116, 85%) were initiated by junior ICU medical staff members seeking clinical information from the GPs. Few consultations were to discuss goals of care (n = 10, 7.3%) or care following ICU discharge (n = 15, 11%). CONCLUSIONS Consultations between ICU medical staff and GPs were infrequent. Further research is required on how best to integrate the health care provided by ICUs and GPs.
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Affiliation(s)
- Sophie A Witherspoon
- University of Melbourne Rural Clinical School, Ground Floor, Medical Building, Cnr Grattan Street & Royal Parade, University of Melbourne, VIC, Australia; Mount Isa Base Hospital, 30 Camooweal Street, Mount Isa, QLD, Australia.
| | | | - Paul Z Power
- Intensive Care Unit, Barwon Health, Bellerine St, Geelong, VIC, Australia
| | - Anne Mulvey
- Intensive Care Unit, Barwon Health, Bellerine St, Geelong, VIC, Australia
| | - Kimberley J Haines
- The University of Melbourne School of Medicine, Department of Critical Care, The University of Melbourne, Grattan Street, Parkville, VIC, Australia; Western Health Department of Physiotherapy, 176 Furlong Rd, St Albans, VIC, Australia
| | - Matthew J Maiden
- Intensive Care Unit, Barwon Health, Bellerine St, Geelong, VIC, Australia; The University of Melbourne School of Medicine, Department of Critical Care, The University of Melbourne, Grattan Street, Parkville, VIC, Australia; University of Adelaide Discipline of Acute Care Medicine, Adelaide, SA, Australia
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Wang YT, Harrison CA, Skinner EH, Haines KJ, Holdsworth C, Lang JK, Hibbert E, Scott D, Eynon N, Tiruvoipati R, French CJ, Stepto NK, Bates S, Walton KL, Crozier TM, Haines TP. Activin A level is associated with physical function in critically ill patients. Aust Crit Care 2023; 36:702-707. [PMID: 36517331 DOI: 10.1016/j.aucc.2022.10.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Activin A is a potent negative regulator of muscle mass elevated in critical illness. It is unclear whether muscle strength and physical function in critically ill humans are associated with elevated activin A levels. OBJECTIVES The objective of this study was to investigate the relationship between serum activin A levels, muscle strength, and physical function at discharge from the intensive care unit (ICU) and hospital. METHODS Thirty-six participants were recruited from two tertiary ICUs in Melbourne, Australia. Participants were included if they were mechanically ventilated for >48 h and expected to have a total ICU stay of >5 days. The primary outcome measure was the Six-Minute Walk Test distance at hospital discharge. Secondary outcome measures included handgrip strength, Medical Research Council Sum Score, Physical Function ICU Test Scored, Six-Minute Walk Test, and Timed Up and Go Test assessed throughout the hospital admission. Total serum activin A levels were measured daily in the ICU. RESULTS High peak activin A was associated with worse Six-Minute Walk Test distance at hospital discharge (linear regression coefficient, 95% confidence interval, p-value: -91.3, -154.2 to -28.4, p = 0.007, respectively). Peak activin A concentration was not associated with the secondary outcome measures. CONCLUSIONS Higher peak activin A may be associated with the functional decline of critically ill patients. Further research is indicated to examine its potential as a therapeutic target and a prospective predictor for muscle wasting in critical illness. STUDY REGISTRATION ACTRN12615000047594.
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Affiliation(s)
- Yi Tian Wang
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Physiotherapy, Peninsula Health, Melbourne, Australia.
| | - Craig A Harrison
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia.
| | - Elizabeth H Skinner
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia; Department of Physiotherapy, Western Health, Melbourne, Australia; Australian Institute of Musculoskeletal Science, The University of Melbourne, Melbourne, Australia.
| | - Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
| | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, Australia.
| | - Jenna K Lang
- Department of Physiotherapy, Western Health, Melbourne, Australia.
| | | | - David Scott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
| | - Nir Eynon
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Ravindranath Tiruvoipati
- Department of Intensive Care, Peninsula Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Peninsula Clinical School, Monash University, Frankston, VIC, Australia.
| | - Craig J French
- Department of Intensive Care, Western Health, Melbourne, Australia.
| | - Nigel K Stepto
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Samantha Bates
- Department of Intensive Care, Western Health, Melbourne, Australia.
| | - Kelly L Walton
- Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Department of Physiology, Monash University, Australia.
| | - Tim M Crozier
- Department of Intensive Care, Monash Health, Melbourne, Australia; Southern Clinical School, Monash University, Melbourne, Australia.
| | - Terry P Haines
- School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Melbourne, Australia.
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Digby R, Manias E, Haines KJ, Orosz J, Ihle J, Bucknall TK. Family experiences and perceptions of intensive care unit care and communication during the COVID-19 pandemic. Aust Crit Care 2023; 36:350-360. [PMID: 35501199 PMCID: PMC8971060 DOI: 10.1016/j.aucc.2022.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In 2020, during the first wave of the COVID-19 pandemic in Melbourne, visitor access to acute hospitals including intensive care units (ICUs) was initially barred, followed by a limit of one person per patient for one hour per day. This study explores the care and communication experienced by family members of ICU patients during this time. METHODS This qualitative descriptive study was conducted at an Australian quaternary hospital. Semistructured phone interviews were conducted using an aide-memoire designed to understand participants' experiences as family of a patient during this time. Interviews were recorded, transcribed, and thematically analysed. FINDINGS Twenty family members of patients in the ICU participated. Three major themes were identified: 'impact of restricting visiting procedures', 'family experiences of communication', and 'care and support'. Inflexible visiting restrictions had a momentous impact on families. Participants objected to having to nominate only two people to visit during the admission and the short visiting time limit. Some family members suffered extreme stress and anxiety during their absence from the bedside. Additional challenges were experienced by rural families, visitors with disabilities, and the young children of patients who were excluded. Communication with clinicians varied. Telehealth was valued by some but not universally embraced. The relationship between staff members and families and involvement in decision-making were unaffected. CONCLUSION Families experienced significant psychological distress from being separated from their critically ill relatives. Patient care and involvement in decision-making appeared to be unchanged, but communication with staff felt to be lacking. Better alternatives to face-to-face communication must be sought to limit the impact of family separation on mental health. Families are a key link between the patient and clinicians and often play a major role in patient support and recovery after discharge. There is an urgent need to support them and facilitate meaningful engagement despite the obstacles.
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Affiliation(s)
- R Digby
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC, 3220, Australia; Alfred Health, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - E Manias
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC, 3220, Australia.
| | - K J Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
| | - J Orosz
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.
| | - J Ihle
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.
| | - T K Bucknall
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC, 3220, Australia; Alfred Health, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
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10
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Haines KJ, Emery KL, Berney SC. Physical therapy and nutrition therapy: synergistic, antagonistic, or independent interventions? Curr Opin Clin Nutr Metab Care 2023; 26:179-185. [PMID: 36892964 DOI: 10.1097/mco.0000000000000913] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE OF REVIEW Physical therapy and nutrition therapy have predominantly been studied separately in the critically ill, however in clinical practice are often delivered in combination. It is important to understand how these interventions interact. This review will summarize the current science - where they are potentially synergistic, antagonistic, or independent interventions. RECENT FINDINGS Only six studies were identified within the ICU setting that combined physical therapy and nutrition therapy. The majority of these were randomized controlled trials with modest sample sizes. There was an indication of benefit in the preservation of femoral muscle mass and short-term physical quality of life - particularly with high-protein delivery and resistance exercise, in patients who were predominantly mechanically ventilated patients, with an ICU length of stay of approximately 4-7 days (varied across studies). Although these benefits did not extend to other outcomes such as reduced length of ventilation, ICU or hospital admission. No recent trials were identified that combined physical therapy and nutrition therapy in post-ICU settings and is an area that warrants investigation. SUMMARY The combination of physical therapy and nutrition therapy might be synergistic when evaluated within the ICU setting. However, more careful work is required to understand the physiological challenges in the delivery of these interventions. Combining these interventions in post-ICU settings is currently under-investigated, but may be important to understand any potential benefits to patient longitudinal recovery.
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Affiliation(s)
- Kimberley J Haines
- Department of Critical Care, School of Medicine, The University of Melbourne
- Department of Physiotherapy, Western Health
| | | | - Sue C Berney
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
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11
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Haines KJ, Sawyer A, McKinnon C, Donovan A, Michael C, Cimoli C, Gregory M, Berney S, Berlowitz DJ. Barriers and enablers to telehealth use by physiotherapists during the COVID-19 pandemic. Physiotherapy 2023; 118:12-19. [PMID: 36308980 PMCID: PMC9450484 DOI: 10.1016/j.physio.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/29/2021] [Revised: 04/07/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate the perceived barriers and enablers experienced by physiotherapists whilst delivering community and outpatient services during the COVID-19 pandemic. METHODS Qualitative study undertaken at a University-affiliated hospital in Melbourne, Australia. Physiotherapists working in the outpatient setting participated in a semi-structured interview. Interviews were analysed using Framework Analysis, with themes mapped to the Theoretical Domains Framework (TDF). RESULTS From 19 interviews, we identified major themes and mapped these to the TDF domains: 1. The pandemic rapidly closed the knowledge-practice gap; 2. Adaptation of existing skills and integration of new skills were required; 3. Supportive senior leadership helped the transition; 4. Capabilities and confidence improved with time; 5. Environmental factors were crucial to success or failure of telehealth; 6. Access to and delivery of care improved for some; 7. Identification of appropriate patients and future hybrid models of care; 8. Changes in work practices, role certainty and identity; 9. Development of educational resources consolidated knowledge; 10. Socialisation of telehealth and optimism for the future. Within each domain, key barriers and enablers were also identified. CONCLUSIONS The findings of this study suggest that the delivery of community and outpatient physiotherapy via telehealth during the COVID-19 pandemic was an initial challenge. Growing knowledge, confidence and ability to problem solve barriers enabled physiotherapists to move along the continuum of 'fear' to 'triumph' as the pandemic progressed. These results can be used by clinicians, managers, and academics to guide future workforce planning, hospital environmental design, and service delivery. CLINICAL MESSAGE.
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Affiliation(s)
- Kimberley J. Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia,Department of Critical Care, School of Medicine, The University of Melbourne, Victoria, Australia,Corresponding author at: Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Abbey Sawyer
- Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia,Institute for Breathing and Sleep, Victoria, Australia
| | - Clare McKinnon
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Ashleigh Donovan
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Chris Michael
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Chris Cimoli
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Mel Gregory
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - David J. Berlowitz
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia,Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
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12
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Digby R, Manias E, Haines KJ, Orosz J, Ihle J, Bucknall TK. Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia. Aust Crit Care 2023; 36:66-76. [PMID: 36464524 PMCID: PMC9574938 DOI: 10.1016/j.aucc.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In 2020, during the first wave of the COVID-19 pandemic in Australia, hospital intensive care units (ICUs) revised patient care practices, curtailed visiting, and augmented the use of personal protective equipment to protect patients, staff, and the community from viral transmission. AIM The aim was to explore ICU staff experiences and perceptions of care and communication with patients during the COVID-19 pandemic to understand how alternative ways of working have influenced work processes, relationships, and staff morale. METHODS This was a qualitative exploratory design study using audio-recorded and transcribed interviews with 20 ICU staff members. Data were analysed using thematic analysis. FINDINGS Four major themes were derived from the data: (i) Communication and connection, (ii) Psychological casualties, (iii) Caring for our patients, and (iv) Overcoming challenges. Patient care was affected by diminished numbers of critical care qualified staff, limited staff entry to isolation rooms, and needing to use alternative techniques for some practices. The importance of effective communication from the organisation and between clinicians, families, and staff members was emphasised. personal protective equipment hindered communication between patients and staff and inhibited nonverbal and verbal cues conveying empathy in therapeutic interactions. Communication with families by phone or videoconference was less satisfying than in-person encounters. Some staff members suffered psychological distress, especially those working with COVID-19 patients requiring extracorporeal membrane oxygenation. Moral injury occurred when staff members were required to deny family access to patients. Workload intensified with increased patient admissions, additional infection control requirements, and the need to communicate with families using alternative methods. CONCLUSION The results of this study reflect the difficulties in communication during the early stages of the COVID-19 pandemic. Communication between staff members and families may be improved using a more structured approach. Staff reported experiencing psychological stress when separating families and patients or working in isolation rooms for prolonged periods. A flexible, compassionate response to family presence in the ICU is essential to maintain patient- and family-centred care.
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Affiliation(s)
- Robin Digby
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC 3220 Australia,Alfred Health, 55 Commercial Rd, Melbourne VIC 3004 Australia,Corresponding author
| | - Elizabeth Manias
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC 3220 Australia
| | - Kimberley J. Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria,Department of Critical Care, School of Medicine, The University of Melbourne, Melbourne, Victoria
| | - Judit Orosz
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Joshua Ihle
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Tracey K. Bucknall
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC 3220 Australia,Alfred Health, 55 Commercial Rd, Melbourne VIC 3004 Australia
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13
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Pazsa FM, Said CM, Haines KJ, Silburn E, Shackell M, Hitch D. The lived experience of patients with obesity at a metropolitan public health setting. BMC Health Serv Res 2022; 22:1530. [PMID: 36527028 PMCID: PMC9756509 DOI: 10.1186/s12913-022-08928-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patient-centred care models for acutely hospitalised people living with obesity are poorly understood and the quality of evidence low. OBJECTIVE The aim of this study was to explore and better understand the lived experience of people living with obesity, in the inpatient hospital context. DESIGN A qualitative methodology using Interpretative Phenomenological Analysis (IPA) was used. Data were collected via a single semi-structured interview with each participant. SETTING AND PARTICIPANTS The study was completed at a metropolitan public health service. Ten previously hospitalised patients who live with obesity were included. RESULTS Three main themes emerged: meeting physical care needs of people with obesity on hospital wards, interpersonal interactions between patients and healthcare professionals, and the psychosocial impact of being obese in the hospital setting. Priorities included timely provision of appropriate equipment and infrastructure design to meet care needs and facilitate better wellbeing. To improve patient experience, an emphasis on basic principles of quality care provision to enhance interpersonal interactions, along with improved awareness of the impact of weight bias and obesity stigma in healthcare are supported. Participants found hospitalisation stressful, but valued support from healthcare professionals regarding weight loss. DISCUSSION These data provide new insights in to the lived experience of people living with obesity in the hospital setting. Items which are low cost, such as appropriately sized chairs and gowns, as well facilitators to independent mobility such as electric wheelchairs are suggested to improve both experience and care outcomes. Interpersonal interactions demonstrated obesity stigma in the hospital setting, with participants expressing the desire for more appropriate communication. People living with obesity self-reflected in the inpatient setting, suggesting that staff should be trained to utilise the opportunity to provide weight loss advice. CONCLUSIONS The themes identified in this study provide insight into the lived experience of people with obesity in hospital. This understanding provides direction for the development of improved models of care for people living with obesity in this setting and beyond.
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Affiliation(s)
- Fiona M. Pazsa
- grid.417072.70000 0004 0645 2884Physiotherapy, Western Health, Melbourne, Victoria Australia ,grid.1008.90000 0001 2179 088XPhysiotherapy, The University of Melbourne, Melbourne, Victoria Australia
| | - Catherine M. Said
- grid.417072.70000 0004 0645 2884Physiotherapy, Western Health, Melbourne, Victoria Australia ,grid.1008.90000 0001 2179 088XPhysiotherapy, The University of Melbourne, Melbourne, Victoria Australia ,grid.508448.50000 0004 7536 0094Australian Institute for Musculoskeletal Science, St Albans, Victoria Australia
| | - Kimberley J. Haines
- grid.417072.70000 0004 0645 2884Physiotherapy, Western Health, Melbourne, Victoria Australia ,grid.1008.90000 0001 2179 088XPhysiotherapy, The University of Melbourne, Melbourne, Victoria Australia
| | - Eloise Silburn
- grid.417072.70000 0004 0645 2884Department of Psychology, Western Health, Melbourne, Victoria Australia
| | - Melina Shackell
- grid.417072.70000 0004 0645 2884Physiotherapy, Western Health, Melbourne, Victoria Australia
| | - Danielle Hitch
- grid.417072.70000 0004 0645 2884Allied Health, Western Health, Melbourne, Victoria Australia ,grid.1021.20000 0001 0526 7079Occupational Therapy, Deakin University, Geelong, Victoria Australia
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14
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Alsubheen SA, Beauchamp MK, Ellerton C, Goldstein R, Alison JA, Dechman G, Haines KJ, Harrison SL, Holland AE, Lee AL, Marques A, Spencer L, Stickland M, Skinner EH, Brooks D. Validity of the Activities-specific Balance Confidence Scale in individuals with chronic obstructive pulmonary disease. Expert Rev Respir Med 2022; 16:689-696. [DOI: 10.1080/17476348.2022.2099378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sanaa A. Alsubheen
- School of Rehabilitation Science, Faculty of Health Science, McMaster University,Hamilton, ON, Canada
| | - Marla K. Beauchamp
- School of Rehabilitation Science, Faculty of Health Science, McMaster University,Hamilton, ON, Canada
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto ON, Canada
| | - Cindy Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto ON, Canada
| | - Roger Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto ON, Canada
- Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto ON, Canada
| | - Jennifer A. Alison
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
- Allied Health, Sydney Local Health District, Sydney, Australia
| | - Gail Dechman
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax NS, Canada
- Department of Medicine, Respirology, Dalhousie University and Nova Scotia Health Authority, Halifax NS, Canada
| | | | - Samantha L. Harrison
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Anne E. Holland
- Department of Physiotherapy, Alfred Health, Melbourne VIC, Australia
- Respiratory Research, Monash University, Melbourne VIC, Australia
- Institute for Breathing and Sleep, Melbourne VIC, Australia
| | - Annemarie L. Lee
- Institute for Breathing and Sleep, Melbourne VIC, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne VIC, Australia
- Department of Allied Health Research, Cabrini Health, Malvern VIC, Australia
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, ESSUA) and Institute of Biomedicine, iBiMED), University of Aveiro, Aveiro, Portugal
| | - Lissa Spencer
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown NSW, Australia
| | - Michael Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton AB, Canada
- G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
| | - Elizabeth H. Skinner
- Physiotherapy Department, Western Health, Melbourne VIC, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne VIC, Australia
| | - Dina Brooks
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto ON, Canada
- Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto ON, Canada
- Respiratory Research, Monash University, Melbourne VIC, Australia
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15
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Bicknell ED, Said CM, Haines KJ, Kuys S. “I Give It Everything for an Hour Then I Sleep for Four.” The Experience of Post-stroke Fatigue During Outpatient Rehabilitation Including the Perspectives of Carers: A Qualitative Study. Front Neurol 2022; 13:900198. [PMID: 35720087 PMCID: PMC9201517 DOI: 10.3389/fneur.2022.900198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fatigue is a debilitating post-stroke symptom negatively impacting rehabilitation. Lack of acknowledgment from carers can be additionally distressing. The purpose of this study was to describe the experience of post-stroke fatigue during outpatient rehabilitation, including the perspectives of carers. Methods This qualitative study was guided by descriptive phenomenology within a constructivist paradigm. Semi-structured interviews were conducted with stroke survivors experiencing fatigue (Fatigue Assessment Scale >23) and attending outpatient rehabilitation. Carers were also interviewed where identified, providing insight into their own and stroke survivor experiences. Data were analyzed according to Colaizzi's analytic method. Results Fourteen stroke survivors (50% culturally and linguistically diverse), and nine carers participated. Six themes were identified: 1. The unpredictable and unprepared uncovering of fatigue; 2. Experience and adjustment are personal 3. Being responsible for self-managing fatigue; 4. The complex juggle of outpatient stroke rehabilitation with fatigue; 5. Learning about fatigue is a self-directed problem-solving experience; 6. Family and carers can support or constrain managing fatigue. Conclusion Despite engaging in outpatient rehabilitation, stroke survivors largely learnt to manage fatigue independent of healthcare professionals. Carers often facilitated learning, monitoring rehabilitation, daily routines and fatigue exacerbation. Conversely, family could be dismissive of fatigue and possess unrealistic expectations. Post-stroke fatigue must be considered by clinicians when delivering outpatient rehabilitation to stroke survivors. Clinicians should consistently screen for fatigue, provide flexible session scheduling, and educate about individual indicators and strategies for management. Clinicians should also explicitly engage carers who play a critical role in the management of fatigue.
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Affiliation(s)
- Erin D. Bicknell
- School of Allied Health, Australian Catholic University, Brisbane, QLD, Australia
- Department of Physiotherapy, Western Health, St Albans, VIC, Australia
- *Correspondence: Erin D. Bicknell
| | - Catherine M. Said
- Department of Physiotherapy, Western Health, St Albans, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science, St Albans, VIC, Australia
| | | | - Suzanne Kuys
- School of Allied Health, Australian Catholic University, Brisbane, QLD, Australia
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16
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Hodgson CL, Higgins AM, Bailey MJ, Mather AM, Beach L, Bellomo R, Bissett B, Boden IJ, Bradley S, Burrell A, Cooper DJ, Fulcher BJ, Haines KJ, Hodgson IT, Hopkins J, Jones AYM, Lane S, Lawrence D, van der Lee L, Liacos J, Linke NJ, Gomes LM, Nickels M, Ntoumenopoulos G, Myles PS, Patman S, Paton M, Pound G, Rai S, Rix A, Rollinson TC, Tipping CJ, Thomas P, Trapani T, Udy AA, Whitehead C, Anderson S, Neto AS. Comparison of 6-Month Outcomes of Survivors of COVID-19 versus Non-COVID-19 Critical Illness. Am J Respir Crit Care Med 2022; 205:1159-1168. [PMID: 35258437 PMCID: PMC9872799 DOI: 10.1164/rccm.202110-2335oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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] [Indexed: 01/27/2023] Open
Abstract
Rationale: The outcomes of survivors of critical illness due to coronavirus disease (COVID-19) compared with non-COVID-19 are yet to be established. Objectives: We aimed to investigate new disability at 6 months in mechanically ventilated patients admitted to Australian ICUs with COVID-19 compared with non-COVID-19. Methods: We included critically ill patients with COVID-19 and non-COVID-19 from two prospective observational studies. Patients were eligible if they were adult (age ⩾ 8 yr) and received ⩾24 hours of mechanical ventilation. In addition, patients with COVID-19 were eligible with a positive laboratory PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Measurements and Main Results: Demographic, intervention, and hospital outcome data were obtained from electronic medical records. Survivors were contacted by telephone for functional outcomes with trained outcome assessors using the World Health Organization Disability Assessment Schedule 2.0. Between March 6, 2020, and April 21, 2021, 120 critically ill patients with COVID-19, and between August 2017 and January 2019, 199 critically ill patients without COVID-19, fulfilled the inclusion criteria. Patients with COVID-19 were older (median [interquartile range], 62 [55-71] vs. 58 [44-69] yr; P = 0.019) with a lower Acute Physiology and Chronic Health Evaluation II score (17 [13-20] vs. 19 [15-23]; P = 0.011). Although duration of ventilation was longer in patients with COVID-19 than in those without COVID-19 (12 [5-19] vs. 4.8 [2.3-8.8] d; P < 0.001), 180-day mortality was similar between the groups (39/120 [32.5%] vs. 70/199 [35.2%]; P = 0.715). The incidence of death or new disability at 180 days was similar (58/93 [62.4%] vs. 99/150 [66/0%]; P = 0.583). Conclusions: At 6 months, there was no difference in new disability for patients requiring mechanical ventilation for acute respiratory failure due to COVID-19 compared with non-COVID-19. Clinical trial registered with www.clinicaltrials.gov (NCT04401254).
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Affiliation(s)
- Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Intensive Care and Hyperbaric Medicine and,Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Alisa M. Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Michael J. Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Anne M. Mather
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Lisa Beach
- Department of Physiotherapy (Allied Health), the Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Critical Care, School of Medicine, and,Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia;,Physiotherapy Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Ianthe J. Boden
- Physiotherapy Department, Launceston General Hospital, Launceston, Tasmania, Australia;,School of Medicine, University of Tasmania, Tasmania, Australia
| | - Scott Bradley
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Aidan Burrell
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Intensive Care and Hyperbaric Medicine and
| | - D. James Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Intensive Care and Hyperbaric Medicine and
| | - Bentley J. Fulcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Kimberley J. Haines
- Department of Critical Care, School of Medicine, and,Physiotherapy Department, Western Health, Melbourne, Victoria, Australia
| | - Isabelle T. Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Jack Hopkins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Alice Y. M. Jones
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Stuart Lane
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Drew Lawrence
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | | | - Jennifer Liacos
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Natalie J. Linke
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Lonni Marques Gomes
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Marc Nickels
- Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Queensland, Australia
| | | | - Paul S. Myles
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shane Patman
- Faculty of Medicine, Nursing and Midwifery, Health Sciences, and Physiotherapy, the University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Physiotherapy, Monash Health, Melbourne, Victoria, Australia
| | - Gemma Pound
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Physiotherapy Department, St. Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Sumeet Rai
- Canberra Health Services, Canberra, Australian Capital Territory, Australia;,Medical School, Australia National University, Canberra, Australian Capital Territory, Australia
| | - Alana Rix
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Thomas C. Rollinson
- Medical School, Australia National University, Canberra, Australian Capital Territory, Australia;,Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Claire J. Tipping
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Peter Thomas
- Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Andrew A. Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Intensive Care and Hyperbaric Medicine and
| | - Christina Whitehead
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Shannah Anderson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Critical Care, School of Medicine, and,Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia;,Department of Physiotherapy, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia; and
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17
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Emery KL, Haines KJ. Yesterday, Today, Tomorrow - A letter to our patient, reflecting on our role as critical care physiotherapists during the COVID19 global pandemic. Aust Crit Care 2022; 35:217-218. [PMID: 35491077 PMCID: PMC9049241 DOI: 10.1016/j.aucc.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kate L Emery
- Department of Physiotherapy, Western Health, 176 Furlong Road, St Albans, Melbourne, Victoria 3021, Australia.
| | - Kimberley J Haines
- Department of Physiotherapy, Western Health, The University of Melbourne, Melbourne, Australia; Department of Critical Care, School of Medicine, The University of Melbourne, Melbourne, Australia
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18
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Alsubheen SA, Beauchamp M, Ellerton C, Goldstein R, Alison J, Dechman G, Haines KJ, Harrison S, Holland A, Lee A, Marques A, Spencer L, Stickland M, Skinner EH, Brooks D. Age and Sex Differences in Balance Outcomes among Individuals with Chronic Obstructive Pulmonary Disease (COPD) at Risk of Falls. COPD 2022; 19:166-173. [PMID: 35392741 DOI: 10.1080/15412555.2022.2038120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
No previous research has examined age and sex differences in balance outcomes in individuals with chronic obstructive pulmonary disease (COPD) at risk of falls. A secondary analysis of baseline data from an ongoing trial of fall prevention in COPD was conducted. Age and sex differences were analyzed for the Berg Balance scale (BBS), Balance Evaluation System Test (BEST test) and Activities-specific Balance Confidence Scale (ABC). Overall, 223 individuals with COPD were included. Females had higher balance impairments than males [BBS: mean (SD) = 47 (8) vs. 49 (6) points; BEST test: 73 (16) vs. 80 (16) points], and a lower confidence to perform functional activities [ABC = 66 (21) vs. 77 (19)]. Compared to a younger age (50-65 years) group, age >65 years was moderately associated with poor balance control [BBS (r = - 0.37), BEST test (r = - 0.33)] and weakly with the ABC scale (r = - 0.13). After controlling for the effect of balance risk factors, age, baseline dyspnea index (BDI), and the 6-min walk test (6-MWT) explained 38% of the variability in the BBS; age, sex, BDI, and 6-MWT explained 40% of the variability in the BEST test; And BDI and the 6-MWT explained 44% of the variability in the ABC scale. This study highlights age and sex differences in balance outcomes among individuals with COPD at risk of falls. Recognition of these differences has implications for pulmonary rehabilitation and fall prevention in COPD, particularly among females and older adults.
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Affiliation(s)
- Sanaa A Alsubheen
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Cindy Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roger Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Alison
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gail Dechman
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Respirology, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Samantha Harrison
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Anne Holland
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,Respiratory Research, Monash University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Annemarie Lee
- Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia.,Centre for Allied Health Research and Education, Cabrini Health, Malvern, VIC, Australia
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA) and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Lissa Spencer
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
| | - Elizabeth H Skinner
- Physiotherapy Department, Western Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Dina Brooks
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia
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19
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Haines KJ. Peer support to improve recovery after critical care for COVID-19. J Physiother 2022; 68:83-85. [PMID: 35382995 PMCID: PMC8976230 DOI: 10.1016/j.jphys.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, Australia; Department of Critical Care, School of Medicine, The University of Melbourne, Melbourne, Australia.
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20
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Guo L, Ryan B, Leditschke IA, Haines KJ, Cook K, Eriksson L, Olusanya O, Selak T, Shekar K, Ramanan M. Impact of unacceptable behaviour between healthcare workers on clinical performance and patient outcomes: a systematic review. BMJ Qual Saf 2022; 31:679-687. [DOI: 10.1136/bmjqs-2021-013955] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/26/2021] [Indexed: 12/12/2022]
Abstract
BackgroundRecent studies suggest that displays of unacceptable behaviour, including bullying, discrimination and harassment, between healthcare workers (HCWs) may impair job performance, and in turn, increase the frequency of medical errors, adverse events and healthcare-related complications. The objective of this systematic review was to summarise the current evidence of the impact of unacceptable behaviour occurring between HCWs on clinical performance and patient outcomes.MethodsWe searched MEDLINE, Embase, PsycINFO and CINAHL from 1 January 1990 to 31 March 2021. The search results were screened by two independent reviewers and studies were included if they were original research that assessed the effects of unacceptable behaviour on clinical performance, quality of care, workplace productivity or patient outcomes. Risk of bias was assessed using tools relevant to the study design and the data were synthesised without meta-analysis.ResultsFrom the 2559 screened studies, 36 studies were included: 22 survey-based studies, 4 qualitative studies, 3 mixed-methods studies, 4 simulation-based randomised controlled trials (RCTs) and 3 other study designs. Most survey-based studies were low quality and demonstrated that HCWs perceived a relationship between unacceptable behaviour and worse clinical performance and patient outcomes. This was supported by a smaller number of higher quality retrospective studies and RCTs. Two of four RCTs produced negative results, possibly reflecting inadequate power or study design limitations. No study demonstrated any beneficial effect of unacceptable behaviour on the study outcomes.ConclusionsDespite the mixed quality of evidence and some inconsistencies in the strengths of associations reported, the overall weight of evidence shows that unacceptable behaviour negatively affects the clinical performance of HCWs, quality of care, workplace productivity and patient outcomes. Future research should focus on the evaluation and implementation of interventions that reduce the frequency of these behaviours.
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21
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Wynter K, Holton S, Trueman M, Bruce S, Sweeney S, Crowe S, Dabscheck A, Eleftheriou P, Booth S, Hitch D, Said CM, Haines KJ, Rasmussen B. OUP accepted manuscript. Occup Med (Lond) 2022; 72:215-224. [PMID: 35304607 PMCID: PMC9189476 DOI: 10.1093/occmed/kqac003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Hospital clinicians report poor psychosocial well-being during the COVID-19 pandemic. Few studies have reported data at more than one time point. Aims To compare psychosocial well-being among hospital clinicians at two different time points during the COVID-19 pandemic in 2020. Methods Participants included doctors, nurses, midwives and allied health clinicians at a multi-site, public health service in Melbourne, Australia. Data were collected via two cross-sectional, online surveys: May to June (wave 1; n = 638) and October to December 2020 (wave 2; n = 358). The Depression, Anxiety and Stress Scale (DASS-21) assessed psychological well-being in the past week. Investigator-devised questions assessed COVID-19 concerns and perceived work impacts. General linear models were used to assess impact of wave on psychological distress. Results There were no significant demographic differences between the two groups. Both positive (e.g. learning experience) and negative (e.g. risk of getting COVID-19) impacts were reported. In both waves, staff were most concerned about health risks to family members. Wave 2 respondents were significantly more likely than wave 1 respondents to indicate concerns about colleagues having COVID-19, increased workloads, leave cancellation and increased conflict at work (all P < 0.001). Adjusting for sex, age, self-rated health and discipline group, depression, anxiety and stress scores were significantly higher for respondents in the second than the first wave (all P < 0.001). Conclusions Psychological well-being of hospital clinicians was significantly worse during the second wave of the COVID-19 pandemic than the first. Sustained occupational and psychosocial support is recommended even when immediate COVID-19 concerns and impacts resolve.
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Affiliation(s)
- Karen Wynter
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, 3220, Australia
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University, Western Health Partnership, St Albans, 3021, Australia
- Correspondence to: Karen Wynter, 1 Gheringhap Street, Geelong, VIC 3220, Australia. Tel: + 61 3 92468413;
| | - Sara Holton
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, 3220, Australia
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University, Western Health Partnership, St Albans, 3021, Australia
| | - Melody Trueman
- Nursing and Midwifery, Western Health, St Albans, 3021, Australia
| | - Suellen Bruce
- People, Culture and Communications, Western Health, Footscray, 3021, Australia
| | - Sue Sweeney
- Nursing and Midwifery, Western Health, St Albans, 3021, Australia
| | - Shane Crowe
- Nursing and Midwifery, Western Health, St Albans, 3021, Australia
| | | | | | - Sarah Booth
- Allied Health, Western Health, St Albans, 3021, Australia
| | - Danielle Hitch
- Allied Health, Western Health, St Albans, 3021, Australia
| | - Catherine M Said
- Allied Health, Western Health, St Albans, 3021, Australia
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, 3010, Australia
- Australian Institute of Musculoskeletal Sciences, St Albans, 3021, Australia
| | | | - Bodil Rasmussen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, 3220, Australia
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University, Western Health Partnership, St Albans, 3021, Australia
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Odense, 5230, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 1165, Denmark
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22
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Hodgson CL, Higgins AM, Bailey MJ, Mather AM, Beach L, Bellomo R, Bissett B, Boden IJ, Bradley S, Burrell A, Cooper DJ, Fulcher BJ, Haines KJ, Hopkins J, Jones AYM, Lane S, Lawrence D, van der Lee L, Liacos J, Linke NJ, Gomes LM, Nickels M, Ntoumenopoulos G, Myles PS, Patman S, Paton M, Pound G, Rai S, Rix A, Rollinson TC, Sivasuthan J, Tipping CJ, Thomas P, Trapani T, Udy AA, Whitehead C, Hodgson IT, Anderson S, Neto AS. The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study. Crit Care 2021; 25:382. [PMID: 34749756 PMCID: PMC8575157 DOI: 10.1186/s13054-021-03794-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/13/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. METHODS In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. RESULTS Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. CONCLUSIONS At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.
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Affiliation(s)
- Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia.
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia.
- Department of Critical Care, School of Medicine, University of Melbourne, Victoria, Australia.
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Victoria, Australia
| | - Anne M Mather
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa Beach
- Department of Physiotherapy (Allied Health), The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Canberra, Australia
- Physiotherapy Department, Canberra Hospital, Canberra, Australia
| | - Ianthe J Boden
- Physiotherapy Department, Launceston General Hospital, Launceston, Tasmania, Australia
- Launceston Clinical School, University of Tasmania, Tasmania, Australia
| | - Scott Bradley
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Aidan Burrell
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - D James Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Bentley J Fulcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kimberley J Haines
- Physiotherapy Department, Western Health, Melbourne, Victoria, Australia
| | - Jack Hopkins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice Y M Jones
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Stuart Lane
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Intensive Care Medicine Nepean Hospital, New South Wales, Australia
| | - Drew Lawrence
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | | | - Jennifer Liacos
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Natalie J Linke
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lonni Marques Gomes
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Marc Nickels
- Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Queensland, Australia
| | | | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shane Patman
- Faculty of Medicine, Nursing and Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash Health, Melbourne, Victoria, Australia
| | - Gemma Pound
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Sumeet Rai
- Canberra Health Services, Canberra, Australia
- Medical School, Australia National University, Canberra, Australia
| | - Alana Rix
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Thomas C Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Janani Sivasuthan
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Claire J Tipping
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Peter Thomas
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Christina Whitehead
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Intensive Care Medicine Nepean Hospital, New South Wales, Australia
| | - Isabelle T Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shannah Anderson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy (Allied Health), The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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23
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Holton S, Wynter K, Trueman M, Bruce S, Sweeney S, Crowe S, Dabscheck A, Eleftheriou P, Booth S, Hitch D, Said CM, Haines KJ, Rasmussen B. Immediate impact of the COVID-19 pandemic on the work and personal lives of Australian hospital clinical staff. AUST HEALTH REV 2021; 45:656-666. [PMID: 34274032 DOI: 10.1071/ah21014] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022]
Abstract
ObjectiveThis study investigated the short-term psychosocial effects of the COVID-19 pandemic on hospital clinical staff, specifically their self-reported concerns and perceived impact on their work and personal lives.MethodsNurses, midwives, doctors and allied health staff at a large metropolitan tertiary health service in Melbourne, Australia, completed an anonymous online cross-sectional survey between 15 May and 10 June 2020. The survey assessed respondents' COVID-19 contact status, concerns related to COVID-19 and other effects of COVID-19. Space was provided for free-text comments.ResultsRespondents were mostly concerned about contracting COVID-19, infecting family members and caring for patients with COVID-19. Concerns about accessing and using personal protective equipment, redeployment and their ability to provide high-quality patient care during the pandemic were also reported. Pregnant staff expressed uncertainty about the possible impact of COVID-19 on their pregnancy. Despite their concerns, few staff had considered resigning, and positive aspects of the pandemic were also described.ConclusionThe COVID-19 pandemic has had a considerable impact on the work and personal lives of hospital clinical staff. Staff, particularly those who are pregnant, would benefit from targeted well-being and support initiatives that address their concerns and help them manage their work and personal lives.What is known about the topic?The COVID-19 pandemic is having an impact on healthcare workers' psychological well-being. Little is known about their COVID-19-related concerns and the perceived impact of the pandemic on their work and personal lives, particularly hospital clinical staff during the 'first wave' of the pandemic in Australia.What does this paper add?This paper contributes to a small but emerging evidence base about the impact of the COVID-19 pandemic on the work and personal lives of hospital clinical staff. Most staff were concerned about their own health and the risk to their families, friends and colleagues. Despite their concerns, few had considered resigning. Uncertainty about the possible impact of COVID-19 on pregnancy was also reported.What are the implications for practitioners?During the current and future pandemics, staff, especially those who are pregnant, would benefit from targeted well-being and support initiatives that address their concerns and help them manage the impact on their health, work and personal lives.
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Affiliation(s)
- Sara Holton
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia. ; ; and Centre for Quality and Patient Safety Research - Western Health Partnership, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia; and Corresponding author.
| | - Karen Wynter
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia. ; ; and Centre for Quality and Patient Safety Research - Western Health Partnership, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Melody Trueman
- Nursing and Midwifery, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ;
| | - Suellen Bruce
- People, Culture and Communications, Western Health, Locked Bag 2, Footscray, Vic. 3011, Australia.
| | - Susan Sweeney
- Nursing and Midwifery, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ;
| | - Shane Crowe
- Nursing and Midwifery, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ;
| | - Adrian Dabscheck
- Medical Services, Western Health, Locked Bag 2, Footscray, Vic. 3011, Australia. ;
| | - Paul Eleftheriou
- Medical Services, Western Health, Locked Bag 2, Footscray, Vic. 3011, Australia. ;
| | - Sarah Booth
- Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ; ;
| | - Danielle Hitch
- Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ; ;
| | - Catherine M Said
- Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ; ; ; and Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, Vic. 3053, Australia; and Australian Institute for Musculoskeletal Science, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Kimberley J Haines
- Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ; ;
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia. ; ; and Centre for Quality and Patient Safety Research - Western Health Partnership, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia; and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 København, Denmark; and Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
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24
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Holton S, Wynter K, Trueman M, Bruce S, Sweeney S, Crowe S, Dabscheck A, Eleftheriou P, Booth S, Hitch D, Said CM, Haines KJ, Rasmussen B. Psychological well-being of Australian hospital clinical staff during the COVID-19 pandemic. AUST HEALTH REV 2021; 45:297-305. [PMID: 33032681 DOI: 10.1071/ah20203] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022]
Abstract
Objective This study assessed the psychological well-being of Australian hospital clinical staff during the COVID-19 pandemic. Methods An anonymous online cross-sectional survey was conducted in a large metropolitan tertiary health service located in Melbourne, Australia. The survey was completed by nurses, midwives, doctors and allied health (AH) staff between 15 May and 10 June 2020. The Depression, Anxiety and Stress Scale - 21 items (DASS-21) assessed the psychological well-being of respondents in the previous week. Results In all, 668 people responded to the survey (nurses/midwives, n=391; doctors, n=138; AH staff, n=139). Of these, 108 (16.2%) had direct contact with people with a COVID-19 diagnosis. Approximately one-quarter of respondents reported symptoms of psychological distress. Between 11% (AH staff) and 29% (nurses/midwives) had anxiety scores in the mild to extremely severe ranges. Nurses and midwives had significantly higher anxiety scores than doctors (P<0.001) and AH staff (P<0.001). Direct contact with people with a COVID-19 diagnosis (P<0.001) and being a nurse or midwife (P<0.001) were associated with higher anxiety scores. Higher ratings of the health service's pandemic response and staff support strategies were protective against depression (P<0.001), anxiety (P<0.05) and stress (P<0.001). Conclusions The COVID-19 pandemic had a significant effect on the psychological well-being of hospital clinical staff, particularly nurses and midwives. Staff would benefit from (additional) targeted supportive interventions during the current and future outbreaks of infectious diseases. What is known about the topic? The outbreak of COVID-19 is having, and will have, a considerable effect on health services. No Australian data about the effect of COVID-19 on the psychological well-being of hospital clinical staff are available. What does this paper add? Australia healthcare providers have experienced considerable emotional distress during the COVID-19 pandemic, particularly nurses and midwives and clinical staff who have had direct contact with people with a COVID-19 diagnosis. In this study, nurses and midwives had significantly higher levels of anxiety, depression and stress during the pandemic than general Australian adult population norms, and significantly more severe anxiety symptoms than medical and AH staff. Despite a lower number of COVID-19 cases and a lower death rate than in other countries, the proportion of Australian hospital clinical staff experiencing distress is similar to that found in other countries. What are the implications for practitioners? Targeted well-being interventions are required to support hospital clinical staff during the current and future outbreaks of infectious diseases and other 'crises' or adverse events.
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Affiliation(s)
- Sara Holton
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia. ; ; and Centre for Quality and Patient Safety Research - Western Health Partnership, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia; and Corresponding author.
| | - Karen Wynter
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia. ; ; and Centre for Quality and Patient Safety Research - Western Health Partnership, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Melody Trueman
- Nursing and Midwifery, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ;
| | - Suellen Bruce
- People, Culture and Communications, Western Health, Locked Bag 2, Footscray, Vic. 3011, Australia.
| | - Susan Sweeney
- Nursing and Midwifery, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ;
| | - Shane Crowe
- Nursing and Midwifery, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ;
| | - Adrian Dabscheck
- Medical Services, Western Health, Locked Bag 2, Footscray, Vic. 3011, Australia. ;
| | - Paul Eleftheriou
- Medical Services, Western Health, Locked Bag 2, Footscray, Vic. 3011, Australia. ;
| | - Sarah Booth
- Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ; ;
| | - Danielle Hitch
- Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ; ;
| | - Catherine M Said
- Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ; ; ; and Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, Vic. 3053, Australia; and Australian Institute for Musculoskeletal Science, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Kimberley J Haines
- Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. ; ; ;
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia. ; ; and Centre for Quality and Patient Safety Research - Western Health Partnership, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia; and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 København, Denmark; and Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
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Ridley EJ, Freeman-Sanderson A, Haines KJ. Surge capacity for critical care specialised allied health professionals in Australia during COVID-19. Aust Crit Care 2021; 34:191-193. [PMID: 32919841 PMCID: PMC7425765 DOI: 10.1016/j.aucc.2020.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/25/2020] [Indexed: 01/19/2023] Open
Abstract
Significant investment in planning and training has occurred across the Australian healthcare sector in response to the COVID-19 pandemic, with a primary focus on the medical and nursing workforce. We provide a short summary of a recently published article titled "Surge capacity of Australian intensive care units associated with COVID-19 admissions" in the Medical Journal of Australia and, importantly, highlight a knowledge gap regarding critical care specialised allied health professional (AHP) workforce planning in Australia. The unique skill set provided by critical care specialised AHPs contributes to patient recovery long after the patient leaves the intensive care unit, with management targeted at reducing disability and improving function, activities of daily living, and quality of life. Allied health workforce planning and preparation during COVID-19 must be considered when planning comprehensive and evidence-based patient care. The work by Litton et al. has highlighted the significant lack of available data in relation to staffing of critical care specialised AHPs in Australia, and this needs to be urgently addressed.
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Affiliation(s)
- Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, 3004, Australia; Nutrition Department, Alfred Health, Melbourne, 3004, Australia.
| | - Amy Freeman-Sanderson
- University of Technology Sydney, Graduate School of Health, Sydney, Australia; Speech Pathology Department, Royal Prince Alfred Hospital, Sydney Local Health District, Australia; Critical Care Division, The George Institute for Global Health, Sydney, Australia
| | - Kimberley J Haines
- Physiotherapy Department, Western Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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McPeake J, Iwashyna TJ, Boehm LM, Hibbert E, Bakhru RN, Bastin AJ, Butcher BW, Eaton TL, Harris W, Hope AA, Jackson J, Johnson A, Kloos JA, Korzick KA, Meyer J, Montgomery-Yates A, Mikkelsen ME, Slack A, Wade D, Still M, Netzer G, Hopkins RO, Quasim T, Sevin CM, Haines KJ. Benefits of Peer Support for Intensive Care Unit Survivors: Sharing Experiences, Care Debriefing, and Altruism. Am J Crit Care 2021; 30:145-149. [PMID: 33566086 DOI: 10.4037/ajcc2021702] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND After critical illness, patients are often left with impairments in physical, social, emotional, and cognitive functioning. Peer support interventions have been implemented internationally to ameliorate these issues. OBJECTIVE To explore what patients believed to be the key mechanisms of effectiveness of peer support programs implemented during critical care recovery. METHODS In a secondary analysis of an international qualitative data set, 66 telephone interviews with patients were undertaken across 14 sites in Australia, the United Kingdom, and the United States to understand the effect of peer support during recovery from critical illness. Prevalent themes were documented with framework analysis. RESULTS Most patients who had been involved in peer support programs reported benefit. Patients described 3 primary mechanisms: (1) sharing experiences, (2) care debriefing, and (3) altruism. CONCLUSION Peer support is a relatively simple intervention that could be implemented to support patients during recovery from critical illness. However, more research is required into how these programs can be implemented in a safe and sustainable way in clinical practice.
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Affiliation(s)
- Joanne McPeake
- Joanne McPeake is a nurse consultant, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom and an honorary senior clinical lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland, United Kingdom, and a research fellow, THIS Institute, University of Cambridge, United Kingdom
| | - Theodore J. Iwashyna
- Theodore J. Iwashyna is a professor of internal medicine, Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor and a research scientist, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan
| | - Leanne M. Boehm
- Leanne M. Boehm is an assistant professor, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Elizabeth Hibbert
- Elizabeth Hibbert is a physiotherapist, Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Rita N. Bakhru
- Rita N. Bakhru is an assistant professor, Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anthony J. Bastin
- Anthony J. Bastin is a consultant in critical care, Department of Perioperative Medicine, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Brad W. Butcher
- Brad W. Butcher is an assistant professor, Department of Critical Care Medicine, University of Pittsburgh Medical Center (UPMC), Pennsylvania
| | - Tammy L. Eaton
- Tammy L. Eaton is a PhD candidate, University of Pittsburgh School of Nursing, and a founder of the Critical Illness Recovery Center at UPMC Mercy
| | - Wendy Harris
- Wendy Harris is a senior nurse, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Aluko A. Hope
- Aluko A. Hope is an associate professor, Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - James Jackson
- James Jackson is a research professor, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Annie Johnson
- Annie Johnson is a nurse practitioner, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Janet A. Kloos
- Janet A. Kloos is a clinical nurse specialist, Department of Acute and Critical Care Nursing, University Hospitals Cleveland Medical Center, Ohio
| | - Karen A. Korzick
- Karen A. Korzick is codirector of critical care medicine and medical director, ICU Survivor Clinic, Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Joel Meyer
- Joel Meyer is critical care consultants, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ashley Montgomery-Yates
- Ashley Montgomery-Yates is an associate professor, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington
| | - Mark E. Mikkelsen
- Mark E. Mikkelsen is an associate professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | - Andrew Slack
- Andrew Slack is a critical care consultant, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Dorothy Wade
- Dorothy Wade is principal health psychologist, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mary Still
- Mary Still is a clinical nurse specialist in critical care, Emory University Hospital (Emory Healthcare), Atlanta, Georgia
| | - Giora Netzer
- Giora Netzer is a professor of medicine and epidemiology, Division of Pulmonary and Critical Care, University of Maryland School of Medicine, and vice president of patient experience, University of Maryland Medical Center
| | - Ramona O. Hopkins
- Ramona O. Hopkins is a senior research associate, Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah; a founding member, Center for Humanizing Critical Care, Intermountain Health Care, Murray, Utah, and a professor, Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
| | - Tara Quasim
- Tara Quasim is a critical care consultant, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde and a senior clinical lecturer, University of Glasgow
| | - Carla M. Sevin
- Carla M. Sevin is an associate professor, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center
| | - Kimberley J. Haines
- Kimberley J. Haines is physiotherapy lead and senior ICU physiotherapist, Department of Physiotherapy, Western Health, Sunshine Hospital, St Albans, Australia and an associate professor, Centre for Integrated Critical Care, University of Melbourne, Australia
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Hope AA, Johnson AA, McPeake J, Felt H, Sevin CM, Mikkelsen ME, Iwashyna TJ, Lassen-Greene C, Haines KJ, Agarwal S, Bakhru RN, Boehm LM, Butcher BW, Drumright K, Eaton TL, Hibbert E, Hoehn KS, Hornstein D, Imperato-Shedden H, Jackson JC, Kloos JA, Lewis A, Meyer J, Montgomery-Yates A, Rojas V, Schorr C, Wade D, Williams C. Establishing a Peer Support Program for Survivors of COVID-19: A Report From the Critical and Acute Illness Recovery Organization. Am J Crit Care 2021; 30:e1-e5. [PMID: 33566061 PMCID: PMC8364567 DOI: 10.4037/ajcc2021675] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Aluko A Hope
- Aluko A. Hope is an associate professor, Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Annie Johnson
- Andrea (Annie) Johnson is a nurse practitioner, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joanne McPeake
- Joanne McPeake is a nurse consultant, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom and a research fellow, THIS Institute, University of Cambridge, United Kingdom
| | - Hali Felt
- Hali Felt is an author and critical care survivor who is working on her second book, titled Extracorporeal: A Memory of Science and Recovery. She lives in Sacramento, California
| | - Carla M Sevin
- Carla M. Sevin is an associate professor, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark E Mikkelsen
- Mark E. Mikkelsen is an associate professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | - Theodore J Iwashyna
- Theodore J. Iwashyna is a professor of internal medicine, Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, and a research scientist, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan
| | - Caroline Lassen-Greene
- Caroline Lassen-Greene is an assistant professor, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
| | - Kimberley J Haines
- Kimberley J. Haines is the physiotherapy lead and senior ICU physiotherapist, Department of Physiotherapy, Western Health, Sunshine Hospital, St Albans, Australia and an associate professor, Centre for Integrated Critical Care, School of Medicine, The University of Melbourne, Australia
| | - Sachin Agarwal
- Sachin Agarwal is an assistant professor, Department of Neurology (Neurocritical Care), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Rita N Bakhru
- Rita N. Bakhru is an assistant professor, Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Leanne M Boehm
- Leanne M. Boehm is an assistant professor, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Brad W Butcher
- Brad W. Butcher is an assistant professor, Department of Critical Care Medicine, University of Pittsburgh Medical Center (UPMC), Pennsylvania
| | - Kelly Drumright
- Kelly Drumright is a clinical nurse leader for the medical intensive care unit, Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee
| | - Tammy L Eaton
- Tammy L. Eaton is a PhD candidate at the University of Pittsburgh, School of Nursing, and a founder of the Critical Illness Recovery Center (CIRC) at UPMC Mercy in Pittsburgh, Pennsyvania
| | - Elizabeth Hibbert
- Elizabeth Hibbert is a physiotherapist, Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Karen Sara Hoehn
- Karen Sara Hoehn is director of the Pediatric Palliative Care Team, University of Chicago, Illinois
| | - David Hornstein
- David Hornstein is an assistant professor, McGill University Health Centre, Program of Critical Care and Internal Medicine, Montreal, Québec, Canada
| | - Heather Imperato-Shedden
- Heather Imperato-Shedden is a social worker and family and patient support specialist, Morristown Medical Center, Morristown, New Jersey
| | - James C Jackson
- James C. Jackson is a research professor, Vanderbilt University Medical Center
| | - Janet A Kloos
- Janet A. Kloos is a clinical nurse specialist, Department of Acute and Critical Care Nursing, University Hospitals Cleveland Medical Center, Ohio
| | - Anna Lewis
- Anna Lewis is a senior social worker, CIRC, UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | - Joel Meyer
- Joel Meyer is a critical care consultant, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ashley Montgomery-Yates
- Ashley Montgomery-Yates is an associate professor, Department of Medicine, University of Kentucky
| | - Veronica Rojas
- Veronica Rojas is a critical care nurse leader, Department of Internal Medicine, Hospital Clínico Universidad de Chile, Santiago
| | - Christa Schorr
- Christa Schorr is a clinical nurse scientist and associate professor, Department of Medicine, Division of Critical Care, Cooper Medical School of Rowan University Health Care in New Jersey
| | - Dorothy Wade
- Dorothy Wade is principal health psychologist, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Cydni Williams
- Cydni Williams is an associate professor, Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health & Science University, Portland
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Auriemma CL, Harhay MO, Haines KJ, Barg FK, Halpern SD, Lyon SM. What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study. Am J Crit Care 2021; 30:11-20. [PMID: 33385204 DOI: 10.4037/ajcc2021398] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite increased emphasis on providing higher-quality patient- and family-centered care in the intensive care unit (ICU), there are no widely accepted definitions of such care in the ICU. OBJECTIVES To determine (1) aspects of care that patients and families valued during their ICU encounter, (2) outcomes that patients and families prioritized after hospital discharge, and (3) outcomes perceived as equivalent to or worse than death. METHODS Semistructured interviews (n = 49) of former patients of an urban, academic medical ICU and their family members. Two investigators reviewed all transcripts line by line to identify key concepts. Codes were created and defined in a codebook with decision rules for their application and were analyzed using qualitative content analysis. RESULTS Salient themes were identified and grouped into 2 major categories: (1) processes of care within the ICU- communication, patient comfort, and a sense that the medical team was "doing everything" (ie, providing exhaustive medical care) and (2) patient and surrogate outcomes after the ICU-survival, quality of life, physical function, and cognitive function. Several outcomes were deemed worse than death: severe cognitive/physical disability, dependence on medical machinery/equipment, and severe/constant pain. CONCLUSION Although survival was important, most participants qualified this preference. Simple measures of mortality rates may not represent patient- or family-centered outcomes in evaluations of ICU-based interventions, and new measures that incorporate functional outcomes and patients' and family members' views of life quality are necessary to promote patient-centered, evidence-based care.
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Affiliation(s)
- Catherine L. Auriemma
- Catherine L. Auriemma is a pulmonary and critical care fellow, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine; Palliative and Advanced Illness Research (PAIR) Center; and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Michael O. Harhay
- Michael O. Harhay is a biostatistician, PAIR Center; and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Kimberley J. Haines
- Kimberley J. Haines is an intensive care unit physiotherapist, Department of Physiotherapy, Western Health; Department of Physiotherapy, The University of Melbourne; and Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Frances K. Barg
- Frances K. Barg is a medical anthropologist, Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine; and Department of Anthropology, University of Pennsylvania School of Arts and Sciences, Philadelphia
| | - Scott D. Halpern
- Scott D. Halpern is a pulmonary and critical care physician, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine; PAIR Center; Leonard Davis Institute of Health Economics; Department of Biostatistics, Epidemiology and Informatics, and Department of Medical Ethics and Health Policy Perelman School of Medicine, University of Pennsylvania
| | - Sarah M. Lyon
- Sarah M. Lyon is a pulmonary and critical care physician, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania; and Department of Medicine, Division of Pulmonary & Critical Care Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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29
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Robinson C, Hibbert E, Bastin AJ, Meyer J, Montgomery-Yates A, Quasim T, Slack A, Mikkelsen ME, Iwashyna TJ, Haines KJ, Sevin CM, McPeake J, Boehm LM. An International Study Exploring the Experience of Survivors of Critical Illness as Volunteers Within ICU Recovery Services. Crit Care Explor 2020; 2:e0273. [PMID: 34124686 DOI: 10.1097/cce.0000000000000273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Many clinicians have implemented follow-up and aftercare to support patients following ICU. Some of this care is supported and facilitated by peer volunteers. There is limited contemporary work that has explicitly explored volunteer roles within ICU recovery services or the experience of volunteers undertaking these roles. We sought to explore the experience of survivors of critical illness, as volunteers, involved in ICU recovery services and understand their motivation for undertaking these roles. Design Qualitative exploration using in-depth semistructured interviews. The study design used an inductive content analysis process. We also documented the roles that were adopted by volunteers in each site involved in the study. Setting Patients and caregivers were sampled from seven sites across three continents. Patients and Subjects Patients and caregivers who had adopted peer-volunteering roles were undertaken. Interventions None. Measurements and Main Results Twelve patient and caregiver peer volunteers were interviewed. Four key themes were identified. These themes related to the experience of volunteers within ICU recovery services and their motivation for undertaking these roles: 1) self-belief and acceptance, 2) developing peer support, 3) social roles and a sense of purpose, and 4) giving back. Overwhelmingly, participants were positive about the role of the volunteer in the critical care setting. Conclusions Peer volunteers undertake a variety of roles in ICU recovery services and during recovery more generally. These roles appear to be of direct benefit to those in these roles. Future research is needed to develop these roles and fully understand the potential impact on the service, including the impact on other patients.
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Affiliation(s)
- Carly Robinson
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Anthony J Bastin
- Department of Perioperative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Joel Meyer
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ashley Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Slack
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Theodore J Iwashyna
- Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia.,School of Physiotherapy, The University of Melbourne, VIC, Australia
| | - Carla M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN.,Cognitive Impairment, Brain dysfunction, and Survivorship (CIBS) Center at Vanderbilt, Nashville, TN
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30
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Haines KJ, McPeake J, Hibbert E, Boehm LM, Aparanji K, Bakhru RN, Bastin AJ, Beesley SJ, Beveridge L, Butcher BW, Drumright K, Eaton TL, Farley T, Firshman P, Fritschle A, Holdsworth C, Hope AA, Johnson A, Kenes MT, Khan BA, Kloos JA, Kross EK, Mactavish P, Meyer J, Montgomery-Yates A, Quasim T, Saft HL, Slack A, Stollings J, Weinhouse G, Whitten J, Netzer G, Hopkins RO, Mikkelsen ME, Iwashyna TJ, Sevin CM. Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives. Crit Care Med 2020; 47:1194-1200. [PMID: 31241499 DOI: 10.1097/ccm.0000000000003818] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them. DESIGN Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data. SETTING Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents. SUBJECTS Clinicians from 21 sites. MEASUREMENT AND MAIN RESULTS Ten enablers and nine barriers to implementation of "ICU follow-up clinics" were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of "peer support groups" were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising. CONCLUSIONS Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom.,School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland, United Kingdom
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | | | | | - Rita N Bakhru
- Wake Forest University School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care, Allergy and Immunology, Winston Salem, NC
| | - Anthony J Bastin
- Department of Peri-operative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sarah J Beesley
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT.,Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT.,Pulmonary Division, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Lynne Beveridge
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kelly Drumright
- Tennessee Valley Healthcare System VA Medical Center, Nashville, TN
| | - Tammy L Eaton
- Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, PA
| | - Thomas Farley
- School of Nursing, University of California San Francisco, San Francisco, CA
| | | | | | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Aluko A Hope
- Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
| | | | - Michael T Kenes
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Babar A Khan
- Indiana University School of Medicine Research Scientist, Regenstrief Institute Inc., Indianapolis, IN
| | - Janet A Kloos
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Erin K Kross
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Pamela Mactavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Joel Meyer
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ashley Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Howard L Saft
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Andrew Slack
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joanna Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
| | - Gerald Weinhouse
- Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA
| | | | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT.,Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT.,Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Theodore J Iwashyna
- Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, MI.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Carla M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
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Affiliation(s)
| | - Sue Berney
- Department of Physiotherapy, Austin Health, Melbourne, Australia
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Haines KJ, Sevin CM, Hibbert E, Boehm LM, Aparanji K, Bakhru RN, Bastin AJ, Beesley SJ, Butcher BW, Drumright K, Eaton TL, Farley T, Firshman P, Fritschle A, Holdsworth C, Hope AA, Johnson A, Kenes MT, Khan BA, Kloos JA, Kross EK, MacLeod-Smith BJ, Mactavish P, Meyer J, Montgomery-Yates A, Quasim T, Saft HL, Slack A, Stollings J, Weinhouse G, Whitten J, Netzer G, Hopkins RO, Mikkelsen ME, Iwashyna TJ, McPeake J. Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives. Intensive Care Med 2019; 45:939-947. [PMID: 31165227 PMCID: PMC6611738 DOI: 10.1007/s00134-019-05647-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/24/2019] [Indexed: 12/27/2022]
Abstract
Objective To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs. Methods Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine’s THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data. Results Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs—new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU—former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them—clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician’s own understanding of patient experience—there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work—this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes. Conclusions The follow-up of patients and families in post-ICU care settings is perceived to improve care within the ICU via five key mechanisms. Further research is required in this novel area. Electronic supplementary material The online version of this article (10.1007/s00134-019-05647-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Sunshine Hospital, Melbourne, Australia.
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
| | - Carla M Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Krishna Aparanji
- Critical Care Medicine, Springfield Clinic, Springfield, IL, USA
| | - Rita N Bakhru
- Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Anthony J Bastin
- Department of Peri-operative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Sarah J Beesley
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA
- Pulmonary Division, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Kelly Drumright
- Tennessee Valley Healthcare System VA Medical Center, Nashville, TN, USA
| | - Tammy L Eaton
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Thomas Farley
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Aluko A Hope
- Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, New York, USA
| | - Annie Johnson
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael T Kenes
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Babar A Khan
- Indiana University School of Medicine Research Scientist, Regenstrief Institute Inc., Indianapolis, IN, USA
| | - Janet A Kloos
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Erin K Kross
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | | | - Pamela Mactavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Joel Meyer
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ashley Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Kentucky, USA
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK
| | - Howard L Saft
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Andrew Slack
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joanna Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerald Weinhouse
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jessica Whitten
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Maryland, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA
- Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK.
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK.
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Haines KJ. Engaging Families in Rehabilitation of People Who Are Critically Ill: An Underutilized Resource. Phys Ther 2018; 98:737-744. [PMID: 30113660 DOI: 10.1093/ptj/pzy066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 08/01/2018] [Indexed: 11/12/2022]
Abstract
Rehabilitation of people who are critically ill has received increased attention in recent years, although this has not extended to specifically facilitating family involvement. Engaging families in the rehabilitation arc has the potential to optimize outcomes. Likely benefits include redirecting family psychological distress into an active participatory role, humanizing the patient illness and recovery experience, and supporting staff and the health care system beyond the constraints of therapy time. This viewpoint explores why families should be engaged in critical care rehabilitation, gives an overview of the evidence for family participation in bedside care, and provides practical implementation strategies and signpost areas for future research.
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Affiliation(s)
- Kimberley J Haines
- Physiotherapy Department, Western Health, Furlong Road, St Albans, Victoria 3021, Australia; and Australia and New Zealand Research Centre, Monash University, 553 St Kilda Rd, VIC 3004, Australia
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Hodgson CL, Haines KJ, Bailey M, Barrett J, Bellomo R, Bucknall T, Gabbe BJ, Higgins AM, Iwashyna TJ, Hunt-Smith J, Murray LJ, Myles PS, Ponsford J, Pilcher D, Udy AA, Walker C, Young M, Jamie Cooper DJ. Predictors of return to work in survivors of critical illness. J Crit Care 2018; 48:21-25. [PMID: 30138904 DOI: 10.1016/j.jcrc.2018.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine predictors of inability to return to work due to health six-months after intensive care admission; and compare functional recovery between patients who had not returned to work and employed patients. METHODS Participants were working adults admitted to ICU who received >24 h of mechanical ventilation. Outcomes included inability to return to work due to health at six-months post-ICU admission, disability, health status, anxiety, depression and post-traumatic stress. RESULTS Of 107 patients, 31 (29%) were unable to return to work due to health at six-months after ICU admission. Predictors of inability to return to work included longer hospital stay (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.08; P = .004); lower Glasgow Coma Scale (GCS) at admission (OR, 0.86; CI, 0.75-0.99; P = .03); and admission due to major trauma (OR, 8.83; CI, 2.57-30.38; P < .001). Compared to employed patients, those who had not returned to work reported higher levels of disability and psychological distress, and poorer health-related quality of life. CONCLUSION Major trauma, lower GCS and increased hospital length of stay predicted inability to return to work due to health at six-months post-ICU admission. Compared to employed patients, those who had not returned to work reported poorer functional recovery.
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Affiliation(s)
- Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia; Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia.
| | - Kimberley J Haines
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; Western Health, PO Box 294, St Albans, VIC 3021, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | - Jonathan Barrett
- Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia; Epworth Health, 89 Bridge Road, Richmond, VIC 3121, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; Austin Health, PO Box 5555, Heidelberg, VIC 3084, Australia
| | - Tracey Bucknall
- The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia; Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; Farr Institute, Swansea University Medical School, Swansea University, UK
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | - Theodore J Iwashyna
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; University of Michigan, MI, USA
| | | | - Lynne J Murray
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | - Paul S Myles
- The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia
| | - Jennie Ponsford
- Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia
| | - Craig Walker
- Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Meredith Young
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia
| | - D J Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia; Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia
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Abstract
Research highlights the psychosocial impact of critical illness on family who typically adopt a caregiver role to the survivor. We review evidence on informal caregiver psychosocial outcomes and interventional studies designed to improve them. We argue informal caregivers have distinct and complex needs that differ from patients. Interventional studies ought to be designed for this cohort with careful attention paid to the timing of interventions. We consider the influence of social isolation on recovery and discuss service improvement approaches to build social support networks to enhance recovery, where caregivers and survivors are involved in the design of aftercare programs.
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Victoria 3021, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow G4 0SF, Scotland; School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow G4 0SF, Scotland; School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland
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Haines KJ, Berney S, Warrillow S, Denehy L. Long-term recovery following critical illness in an Australian cohort. J Intensive Care 2018; 6:8. [PMID: 29445502 PMCID: PMC5800039 DOI: 10.1186/s40560-018-0276-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/22/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Almost all data on 5-year outcomes for critical care survivors come from North America and Europe. The aim of this study was to investigate long-term mortality, physical function, psychological outcomes and health-related quality of life in a mixed intensive care unit cohort in Australia. METHODS This longitudinal study evaluated 4- to 5-year outcomes. Physical function (six-minute walk test) and health-related quality of life (Short Form 36 Version 2) were compared to 1-year outcomes and population norms. New psychological data (Center for Epidemiological Studies-Depression, Impact of Events Scale) was collected at follow-up. RESULTS Of the 150 participants, 66 (44%) patients were deceased by follow-up. Fifty-six survivors were included with a mean (SD) age of 64 (14.2). Survivors' mean (SD) six-minute walk distance increased between 1 and 4 to 5 years (465.8 m (148.9) vs. 507.5 m (118.2)) (mean difference = - 24.5 m, CI - 58.3, 9.2, p = 0.15). Depressive symptoms were low: median (IQR) score of 7.0 (1.0-15.0). The mean level of post-traumatic stress symptoms was low-median (IQR) score of 1.0 (0-11.0)-with only 9 (16%) above the threshold for potentially disordered symptoms. Short-Form 36 Physical and Mental Component Scores did not change between 1 and 4 to 5 years (46.4 (7.9) vs. 46.7 (8.1) and 48.8 (13) vs. 48.8 (11.1)) and were within a standard deviation of normal. CONCLUSIONS Outcomes of critical illness are not uniform across nations. Mortality was increased in this cohort; however, survivors achieved a high level of recovery for physical function and health-related quality of life with low psychological morbidity at follow-up. TRIAL REGISTRATION The trial was registered with the Australian New Zealand Clinical Trials Registry ACTRN12605000776606.
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Affiliation(s)
- Kimberley J. Haines
- Physiotherapy Department, Western Health, Furlong Road, St. Albans, VIC 3021 Australia
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Parkville, VIC 3010 Australia
| | - Sue Berney
- Department of Physiotherapy, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084 Australia
| | - Stephen Warrillow
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084 Australia
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Parkville, VIC 3010 Australia
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Haines KJ, Skinner EH, Pastva A, Berney S, Denehy L. How Can Clinicians Use Outcome Measures in Routine Care? Knowledge Translation Strategies. Curr Phys Med Rehabil Rep 2015. [DOI: 10.1007/s40141-015-0100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Skinner EH, Haines KJ, Berney S, Warrillow S, Harrold M, Denehy L. Usual Care Physiotherapy During Acute Hospitalization in Subjects Admitted to the ICU: An Observational Cohort Study. Respir Care 2015; 60:1476-85. [PMID: 26374909 PMCID: PMC9993754 DOI: 10.4187/respcare.04064] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Physiotherapists play an important role in the provision of multidisciplinary team-based care in the ICU. No studies have reported usual care respiratory management or usual care on the wards following ICU discharge by these providers. This study aimed to investigate usual care physiotherapy for ICU subjects during acute hospitalization. METHODS One hundred subjects were recruited for an observational study from a tertiary Australian ICU. The frequency and type of documented physiotherapist assessment and treatment were extracted retrospectively from medical records. RESULTS The sample had median (interquartile range) APACHE II score of 17 (13-21) and was mostly male with a median (interquartile range) age of 61 (49-73) y. Physiotherapists reviewed 94% of subjects in the ICU (median of 5 [3-9] occasions, median stay of 4.3 [3-7] d) and 89% of subjects in acute wards (median of 6 [2-12] occasions, median stay of 13.3 [6-28] d). Positioning, ventilator lung hyperinflation, and suctioning were the most frequently performed respiratory care activities in the ICU. The time from ICU admission until ambulation from the bed with a physiotherapist had a median of 5 (3-8) d. The average ambulation distance per treatment had a median of 0 (0-60) m in the ICU and 44 (8-78) m in the acute wards. Adverse event rates were 3.5% in the ICU and 1.8% on the wards. CONCLUSIONS Subjects received a higher frequency of physiotherapy in the ICU than on acute wards. Consensus is required to ensure consistency in data collection internationally to facilitate comparison of outcomes.
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Affiliation(s)
- Elizabeth H Skinner
- Department of Physiotherapy, Western Health, Footscray, and the Allied Health Research Unit, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Melbourne, Victoria, Australia. School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. Department of Physiotherapy, Austin Health, Heidelberg, Melbourne, Victoria, Australia.
| | - Kimberley J Haines
- Department of Physiotherapy, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Sue Berney
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. Department of Physiotherapy, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Stephen Warrillow
- Department of Physiotherapy, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Meg Harrold
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Linda Denehy
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Skinner EH, Haines KJ, Hayes K, Seller D, Toohey JC, Reeve JC, Holdsworth C, Haines TP. Future of specialised roles in allied health practice: who is responsible? AUST HEALTH REV 2015; 39:255-259. [DOI: 10.1071/ah14213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/13/2015] [Indexed: 11/23/2022]
Abstract
Allied health professions have developed specialised advanced and extended scope roles over the past decade, for the benefit of patient outcomes, allied health professionals’ satisfaction and to meet labour and workforce demands. There is an essential need for formalised, widely recognised training to support these roles, and significant challenges to the delivery of such training exist. Many of these roles function in the absence of specifically defined standards of clinical practice and it is unclear where the responsibility for training provision lies. In a case example of physiotherapy practice in the intensive care unit, clinical placements and independence of practice are not core components of undergraduate physiotherapy degrees. Universities face barriers to the delivery of postgraduate specialised training and, although hospital physiotherapy departments are ideally placed, resources for training are lacking and education is not traditionally considered part of healthcare service providers’ core business. Substantial variability in training, and its evaluation, leads to variability in practice and may affect patient outcomes. Allied health professionals working in specialised roles should develop specific clinical standards of practice, restructure models of health care delivery to facilitate training, continue to develop the evidence base for their roles and target and evaluate training efficacy to achieve independent practice in a cost-effective manner. Healthcare providers must work with universities, the vocational training sector and government to optimise the ability of allied health to influence decision making and care outcomes for patients.
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Haines KJ. Lorenzo in Wonderland: a short play based upon the death of D. H. Lawrence. Suicide Life Threat Behav 1978; 8:250-6. [PMID: 369060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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