Development and psychometric evaluation of the family intensive care units syndrome inventory

BACKGROUND

Family members of patient in the intensive care unit (ICU) experience a set of problems which are entitled Family Intensive Care Units Syndrome (FICUS).

OBJECTIVES

The aim of this study was to develop and psychometrically evaluate the FICUS Inventory (FICUSI) in Iran.

METHODS

This sequential exploratory mixed method study was conducted in 2020 in two main phases. In the first phase, FICUSI was developed based on the results of an integrative review and a qualitative study. In the second phase, the psychometric properties of FICUSI, namely, face, content, and construct validity, reliability, responsiveness, interpretability, and scoring, were evaluated. The sample for the construct validity evaluation consisted of 283 ICU family members.

RESULTS

The primary item pool of FICUSI had 144 items and was reduced to 65 items or omitting overlapping and similar items. The scale-level content validity index of FICUSI was 0.89. In the construct validity evaluation through exploratory factor analysis, 31 items with factor loading values more than 0.3 were loaded on two factors (namely psychological symptoms and nonpsychological symptoms) which explained 68.45% of the total variance. The Cronbach's alpha and the test-retest intraclass correlation coefficient of FICUSI were 0.95 and 0.97, respectively.

CONCLUSION

FICUSI is a valid and reliable instrument which can be used in clinical settings and studies for FICUS assessment. Further studies for the cross-cultural adaptation of FICUSI in other contexts are recommended.

RELEVANCE TO CLINICAL PRACTICE

Health care providers in clinical settings can use FICUSI to assess FICUS among the family caregivers of patients in ICU. Health care providers' better understanding of FICUS helps them understand the quality of their own services for the family members of patients in ICU.

Preventing pressure injury in open-heart surgical patients: A systematic review

Background

Cardiac surgical patients are highly prone to developing surgery-related Pressure injuries (PIs). Prevention of PIs is an important patient safety priority in healthcare settings and patients care. So the aim of this study is to detect the effectiveness of prevention strategies to decrease PIs prevalence and incidence in patients undergoing open heart surgery.

Method

We identified studies through Web of Science, Scopus, PubMed, Cochrane, and ProQuest databases from inception through September 2022 with restrictions on the English language. Cochrane RoB 2, JBI, and NIH checklist were carried out as critical appraisal Tools to investigate the studies risk of bias. Finally, 10 studies with a total sample No. 1348, which fulfilled eligibility criteria were included in final systematic review.

Result

Most common interventions investigated in included studies were addressing impairments skin care which included the use of multilayer silicone foam, Care bundle and multiple intervention programs, alternative head inflatable pads, pressure-reducing foam mattresses, and electric bed frames as the effective PIs Prevention (PIP) strategies. While repositioning is one of the important causes mentioned in most PIP protocols, there was not adequate evidence to recommend any special turning regimens for PIP.

Conclusion

Given current evidence, multilayer silicone foam, Care bundle and multiple intervention programs, alternative inflatable head pads, pressure-reducing foam mattresses, and electric bed frames are effective strategies to prevent pressure ulcers. Further investigations are needed to specify the cost-effectiveness of mentioned strategies and RCTs to determine other PIP strategies such as repositioning and mobilization, nutritional supplementation, creams, and co-interventions effects.

The family intensive care unit syndrome: A qualitative content analysis

BACKGROUND

Hospitalization of patients in an intensive care unit (ICU) is associated with a series of psychological problems for their family members called family intensive care unit syndrome (FICUS). Nonetheless, family members of patients in ICU often receive little attention from health care providers. Exploring family members' experiences of their patients' hospitalization in ICU helps health care providers focus more clearly on their problems.

AIMS AND OBJECTIVES

This study aimed to explore FICUS-related experiences among the family members of patients in ICU.

DESIGN

This was a qualitative content analysis study.

METHODS

This qualitative study was conducted in 2019. Participants were 14 family members of patients in ICU who were purposively selected from three hospitals in Tehran, Iran. Data were collected using semi-structured interviews and were analyzed using qualitative content analysis.

RESULTS

Participants' experiences of FICUS fell into four categories, that is, threat to psychological well-being (with four subcategories), threat to physical health (with three subcategories), threat to social health (with three subcategories), and change in spiritual orientation (with two subcategories). The 12 subcategories of these categories were emotional disturbances, hopelessness, changes in sleep pattern, mood changes, physical symptoms, aggravation of the existing illnesses, negligence towards personal health, alteration in social interactions, alteration in the burden of responsibility, alternation in the life process, resort to spiritual beliefs, and spiritual conflict, respectively.

CONCLUSION

FICUS symptoms are not limited to psychological problems, rather they include a wide range of psychological, physical, social, and spiritual problems, which can affect the different aspects of family members' lives. Along with care delivery to patients in ICU, health care providers should provide care and support to patients' family members.

RELEVANCE TO CLINICAL PRACTICE

FICUS is a major threat to health among the family members of patients in ICU. Careful assessment of these family members helps identify family members who are at risk for FICUS and identify FICUS effects on their decisions and health status.

Family Intensive Care Unit Syndrome: An Integrative Review

Background:

Hospitalization in the Intensive Care Unit (ICU) brings about psychological and physical symptoms in patients' family members. Family Intensive Care Unit Syndrome (FICUS) is a term used to explain the psychological symptoms of the family of a patient in response to the patient's admission to the ICU. The purpose of this study was to define FICUS along with its symptoms and predictors.

Materials and Methods:

The Web of Science, PubMed, Scopus, Google Scholar, and SID databases were searched for literature published in 2005–2018 with the keywords “FICUS,” “intensive care unit,” “family,” “caregivers,” “anxiety,” “depression,” and “post-traumatic stress disorder” in their title and abstract. The strategy for conducting an integrative review provided by Whittemore and Knafl (2005) was used in this study.

Results:

Twenty articles were included in the final data analysis. Following the patient's admission to the ICU, family members experience multiple psychological symptoms such as FICUS. The most commonly reported symptoms were anxiety, depression, post-traumatic stress disorder (PTSD), complicated grief, sleep disorder, stress, and fatigue. The low education level, having a critically-ill spouse, adequate support, financial stability, preference for decision-making, understanding of the disease process, anxiety, depression, or previous acute stress were predictors of FICUS.

Conclusions:

On the basis of the results, families also experience physical symptoms, so the FICUS is not limited to the occurrence of psychological symptoms. This study found that there is no universal definition for the term “FICUS” in the research literature. Thus, further research is needed to explore FICUS in the health field.

The effect of evidence-based care guidelines on outcomes after removal of arterial sheath in patients undergoing angioplasty

BACKGROUND

Evidence-based clinical care guidelines effectively assists medical teams to increase the quality of clinical practice, and improve outcomes in patients. This study aimed to design and implement evidence-based care guidelines for removing arterial sheath in patients undergoing angioplasty of coronary artery.

METHODS

This clinical trial study was performed on 200 patients (two groups of 100 patients) with mean age of 62.5 ± 10.8 years, from July 2014 to February 2014 in Baqiyatallah University of Medical Sciences (BUMS), Tehran, Iran. First, we designed a five-step guideline for removing arterial sheath. Then, the designed guideline (based on five-step Stetler model, i.e. preparation, validation, comparative study, implementation, and execution) in the current study, and the routine guideline were used for removing arterial sheath in patients in the intervention and the control groups, respectively. In both groups, the relevant outcomes including bleeding, vasovagal reactions, urinary retention, and pain were evaluated.

RESULTS

There were significant differences between the two groups in terms of bleeding, hematoma, vasovagal reactions (n = 11 versus n = 24), urinary retention (n = 8 versus n = 31), and back pain after removing arterial sheath (P < 0.050 for all).

CONCLUSION

Based on the results of this study, the use of evidence-based care guidelines after removal of atrial sheath in patients undergoing angioplasty is recommended.

Adaptive Support Ventilation Reduces the Incidence of Atelectasis in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Clinical Trial

Background

Pulmonary complications are common following cardiac surgery and can lead to increased morbidity, mortality, and healthcare costs. Atelectasis is the most common respiratory complication following cardiac surgery. One of the most important methods for reducing pulmonary complications is supportive care with protective ventilation strategies. In this study, we aimed to assess the effect of adaptive support ventilation (ASV) on atelectasis in patients undergoing cardiac surgery.

Methods

In this single-blind randomized clinical trial, 115 patients, undergoing coronary artery bypass grafting, were randomly allocated into 2 groups: 57 patients in the intervention and 58 patients in the control group. Patients in the intervention group were weaned with ASV, while patients in the control group were managed using synchronized intermittent mandatory ventilation (SIMV) and pressure support. The incidence of atelectasis, duration of mechanical ventilation, manual ventilator setting, arterial blood gas measurements, and length of hospital stay were compared between the groups.

Results

The incidence of atelectasis, number of changes in the manual ventilator setting, number of alarms, and length of hospital stay reduced in the intervention group. However, duration of mechanical ventilation and number of ABG measurements were not significantly different between the groups.

Conclusions

The ASV mode could reduce the incidence of atelectasis and length of hospital stay. However, it did not reduce the duration of mechanical ventilation. It seems that ASV is not a superior mode for faster extubation.

Assessment Competency of Nurses in Biological Incidents

Background:

There are two main areas within emergency care which focus on departmental and staff preparedness in biological incidents. Despite the importance, little is known about the nurse’s preparedness in facing these events.

Objectives:

The aim of this study was to assess the effect of two teaching methods (multimedia instructional module versus lecture presentation) on nurse’s competency in biological incidents.

Materials and Methods:

In this quasi-experimental study, 90 nurses were randomly divided into three groups (lecture presentation, multimedia- compact disk, and control). Data were collected by thirty-four multiple-choice questions for measuring knowledge, and a visual analogue scale graded 0 - 100 for assessing attitude. Data were analyzed using a paired t-test and one-way ANOVA with SPSS version 17.0. A P value less than 0.05 was considered as statistically significant.

Results:

The results revealed no statistically significant difference in nurse’s competency mean scores between the lecture and multimedia CDs groups.

Conclusions:

It is recommended to use multimedia CDs for in-service education of nurses.

Development and psychometric evaluation of a questionnaire on nurses' clinical competence eye care in intensive care unit patients

BACKGROUND

Given the high prevalence of eye disorders in intensive care units, evaluating critical care nurses' competence in providing standard eye care is a matter of utmost importance. However, to the best of our knowledge, there is no valid questionnaire for measuring nurses' competence to undertake eye care.

AIMS

The aim of this study was to develop and evaluate the psychometric properties of a questionnaire on nurses' clinical competence in providing eye care to patients hospitalized in intensive care units.

DESIGN

This was a psychometric study.

METHODS

We initially performed a literature review and developed a 38-item questionnaire consisting of knowledge, attitude and practice domains. We invited a panel of experts and a group of critical care nurses to assess the content and face validity of the questionnaire. Thereafter, we evaluated its construct validity by using the exploratory factor analysis and the known-groups comparison technique. Moreover, the test-retest and the internal consistency evaluation techniques were used for assessing the reliability of the questionnaire.

RESULTS

Totally, 35 items remained in the final version of the questionnaire. Based on the results of the exploratory factor analysis, we categorized the items of the questionnaire into three factors. The Cronbach's alpha for the attitude and the practice domains as well as the Kuder-Richardson 20 for the knowledge domain showed satisfactory internal consistency. The Cronbach's alpha for the whole questionnaire also was 0·83.

CONCLUSION

The results of this study suggest that the nurses' clinical competence in eye care questionnaire has a good factor structure and an acceptable reliability.

RELEVANCE TO CLINICAL PRACTICE

A complication of sedation and coma is that some patients are unable to maintain effective eyelid closure. These patients present a higher risk of eye complications. Development of tools for evaluating nurses' competence in providing standard eye care is a fundamental prerequisite for improving the quality of eye care.