Australian Intensive Care Unit Research Articles

Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities.

Central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) result in poor clinical outcomes and increased costs. Although frequently regarded as preventable, infection risk may be influenced by non-modifiable factors. The objectives of this study were to evaluate organisational factors associated with CLABSI in Victorian ICUs to determine the nature and relative contribution of modifiable and non-modifiable risk factors. Data captured by the Australian and New Zealand Intensive Care Society regarding ICU-admitted patients and resources were linked to CLABSI surveillance data collated by the Victorian Healthcare Associated Infection Surveillance System between 1 January 2010 and 31 December 2013. Accepted CLABSI surveillance methods were applied and hospital/patient characteristics were classified as 'modifiable' and 'non-modifiable', enabling longitudinal Poisson regression modelling of CLABSI risk. In total, 26 ICUs were studied. Annual CLABSI rates were 1·72, 1·37, 1·00 and 0·93/1000 CVC days for 2010-2013. Of non-modifiable factors, the number of non-invasively ventilated patients standardised to total ICU bed days was found to be independently associated with infection (RR 1·07; 95% CI 1·01-1·13; P = 0·030). Modelling of modifiable risk factors demonstrated the existence of a policy for mandatory ultrasound guidance for central venous catheter (CVC) localisation (RR 0·51; 95% CI 0·37-0·70; P < 0·001) and increased number of sessional specialist full-time equivalents (RR 0·52; 95% CI 0·29-0·93; P = 0·027) to be independently associated with protection against infection. Modifiable factors associated with reduced CLABSI risk include ultrasound guidance for CVC localisation and increased availability of sessional medical specialists.

Barriers to families' regaining control in ICU: Disconnectedness.

The nature of interactions between health care professionals and families may have a significant impact on families' experience and outcomes of critical illness. The value of encouraging positive relationships with families is well documented; however, it is argued that the lack of theoretical frameworks to guide practice in this area may be a barrier to improving patient- and family-centred care. The study on which this paper is based aimed to understand families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit and to generate a substantive theory that represents families' interactions that can be used to guide critical care nursing practice when caring for patients' families in this context. A grounded theory methodology was adopted for the study. Data were collected between 2009 and 2013 using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit (ICU) in Australia. A core category of regaining control has been generated from our study. This paper focuses on Disconnectedness, which leads to increased emotional vulnerability and is also a barrier to families' regaining control. Families feel disconnected when staff emotionally and physically disengage from them, when staff interact insensitively and in a manner that offers families limited hope. Our findings offer an in-depth understanding of staff engagement with families and its impact on the families' ability to regain control. Although some themes have been previously identified in the literature in isolation, the interrelationships of the categories within a theoretical framework to represent family resilience in the context of an ICU situated in the Australian health care system are a novel finding. The findings can be used to support patient- and family-centred care interventions in the ICU.

Characteristics and outcomes of oncology patients requiring admission to an Australian intensive care unit.

e21653 Background: Patients with advanced malignancies have historically been considered poor candidates for the intensive care unit (ICU), however survival and prognosis is continually improving and requirements for use of intensive care services is increasing. This study aimed to understand the characteristics and outcomes of oncology patients admitted to an Australian ICU and identify potential prognostic factors. Methods: A single-centre, retrospective, cohort study was conducted at Royal North Shore Hospital, a tertiary public hospital in Sydney, Australia with a 58-bed quaternary ICU. All patients aged &gt; 18 years, admitted under the medical oncology team requiring ICU admission between June 2014 and June 2016 were evaluated. Data collected included basic demographics, cancer type and status, performance status (ECOG) and co-morbidities (ACE-27 score). Clinical outcomes were determined including ICU and hospital mortality, requirements (ventilation, dialysis, vasopressors, infection) and APACHE II scores. Results: There were 96 patients admitted to the ICU during the study period. Mean age was 61 years, 58% were male and 76% had metastatic disease. Most patients were receiving palliative treatment (89%), with recent chemotherapy (43%), immunotherapy (10%) and other therapies (5%). Of the 10 patients with recent immunotherapy, three (all melanoma) required ICU admission due to immunotoxicity with all three alive at time of data collection (mean 222 days follow-up). 13% were admitted due to an oncological emergency. Most common primary tumour site was thoracic (20%), genitourinary (11%), breast (10%) and melanoma (10%). Mean APACHE II score was 17 (SD 5.33), mean SOFA score was 4 (SD 2.70), ICU mortality was 5% and hospital mortality was 22%. For the 75 patients (78%) discharged from hospital, 42 (56%) were still alive at time of data collection (mean 321 days follow-up). Conclusions: Our patient population had good short-term outcomes for survival despite most receiving palliative treatment, although prognostic scores were also favourable. This suggests cancer patients can achieve positive outcomes after ICU admission with appropriate selection of patients crucial.

Modelling risk-adjusted variation in length of stay among Australian and New Zealand ICUs.

PurposeComparisons between institutions of intensive care unit (ICU) length of stay (LOS) are significantly confounded by individual patient characteristics, and currently there is a paucity of methods available to calculate risk-adjusted metrics.MethodsWe extracted de-identified data from the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database for admissions between January 1 2011 and December 31 2015. We used a mixed-effects log-normal regression model to predict LOS using patient and admission characteristics. We calculated a risk-adjusted LOS ratio (RALOSR) by dividing the geometric mean observed LOS by the exponent of the expected Ln-LOS for each site and year. The RALOSR is scaled such that values <1 indicate a LOS shorter than expected, while values >1 indicate a LOS longer than expected. Secondary mixed effects regression modelling was used to assess the stability of the estimate in units over time.ResultsDuring the study there were a total of 662,525 admissions to 168 units (median annual admissions = 767, IQR:426–1121). The mean observed LOS was 3.21 days (median = 1.79 IQR = 0.92–3.52) over the entire period, and declined on average 1.97 hours per year (95%CI:1.76–2.18) from 2011 to 2015. The RALOSR varied considerably between units, ranging from 0.35 to 2.34 indicating large differences after accounting for case-mix.ConclusionsThere are large disparities in risk-adjusted LOS among Australian and New Zealand ICUs which may reflect differences in resource utilization.

A snapshot of the oxygenation of mechanically ventilated patients in one Australian intensive care unit.

Hyperoxaemia in patients undergoing mechanical ventilation (MV) has been found to be an independent predictor of worse outcome and in-hospital mortality in some conditions. Data suggests that a fraction of inspired oxygen (FiO2) of 0.4 or lower may produce hyperoxaemia although it is commonly accepted without adjustment in ventilator settings. The primary aim of this study was to observe current practice at one Australian tertiary intensive care unit (ICU) with regard to prescription and titration of oxygen (O2) in patients undergoing MV, in particular whether they received higher FiO2 than required according to arterial blood gas (ABG) results, and whether there was FiO2 titration as a response to initial ABG results during the 12 hours following. A retrospective observational study of 151 ICU patients undergoing MV between November 2013 and February 2014 was conducted, with ABGs as the primary outcome measure. There were 250 ABG measures, with mean FiO2 0.38 (range 0.3-1.0) and mean PaO2 114 mmHg (standard deviation 36). Over all observations, 197 (79%) were of FiO2 ≤0.4, however no patients were ventilated on room air (FiO2 0.21) and 114 (46%) were in the hyperoxaemic range. Oxygen titration (up or down) occurred in 31% of patients. Morning ABGs were taken at a time suggested by ICU guidelines, and on review of these measures, the mean FiO2 was lower than that purported to create toxicity. Subsequently, almost one-third of the cohort had their FiO2 titrated, however there was a floor effect whereby 39%-43% of the cohort received an FiO2 of 0.3.

Barriers to regaining control within a constructivist grounded theory of family resilience in ICU: Living with uncertainty.

To discuss families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit. The overwhelming emotions associated with the unexpected admission of a relative to an intensive care unit are often due to the uncertainty surrounding the condition of their critically ill relative. There is limited in-depth understanding of the nature of uncertainty experienced by families in intensive care, and interventions perceived by families to minimise their uncertainty are not well documented. Furthermore, the interrelationships between factors, such as staff-family interactions and the intensive care unit environment, and its influence on families' uncertainty particularly in the context of the Australian healthcare system, are not well delineated. A grounded theory methodology was adopted for the study. Datawerecollected between 2009-2013, using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit in Australia. This paper describes the families experiences of heightened emotional vulnerability and uncertainty when a relative is admitted unexpectedly to the intensive care unit. Families uncertainty is directly influenced by their emotional state, the foreign environment and perceptions of being 'kept in the dark', as well as the interrelationships between these factors. Staff are offered an improved understanding of the barriers to families' ability to regain control, guided by a grounded theory of family resilience in the intensive care unit. The findings reveal in-depth understanding of families' uncertainty in intensive care. It suggests that intensive care unit staff need to focus clinical interventions on reducing factors that heighten their uncertainty, while optimising strategies that help alleviate it. Families are facilitated to move beyond feelings of helplessness and loss of control, and cope better with their situation.

A survey of clinicians regarding respiratory physiotherapy intervention for intubated and mechanically ventilated patients with community-acquired pneumonia. What is current practice in Australian ICUs?

Community-acquired pneumonia (CAP) is a common cause for intensive care unit (ICU) admission resulting in high morbidity and mortality. There is a paucity of evidence regarding respiratory physiotherapy for intubated and mechanically ventilated patients with CAP, and anecdotally clinical practice is variable in this cohort. The aims of this study were to identify the degree of variability in physiotherapy practice for intubated adult patients with CAP and to explore ICU physiotherapist perceptions of current practice for this cohort and factors that influence physiotherapy treatment mode, duration, and frequency. A survey was developed based on common aspects of assessment, clinical rationale, and intervention for intubated and mechanically ventilated patients. Senior ICU physiotherapists across 88 Australian public and private hospitals were recruited. The response rate was 72%. Respondents (n=75) stated their main rationale for providing a respiratory intervention were improved airway clearance (98%, n=60/61), alveolar recruitment (74%, n=45/61), and gas exchange (33%, n=20/61). Respondents estimated that average intervention lasted between 16 and 30minutes (70% of respondents, n=41/59) and would be delivered once (44%) or twice (44%) daily. Results indicated large variability in reported practice; however, trends existed regarding positioning in alternate side-lying (81%, n=52/64) or affected lung uppermost (83%, n=53/64) and use of hyperinflation techniques (81%, 52/64). Decisions regarding duration were reported to be based on sputum volume (95%), viscosity (93%) and purulence (88%), cough effectiveness (95%), chest X-ray (87%), and auscultation (84%). Sixty percent reported that workload and staffing affected intervention duration and frequency. Intervention time was more likely increased when there was greater staffing (P=.03). Respiratory physiotherapy treatment varies for intubated patients with CAP. Further research is required to determine what is considered best practice for this patient population.

Intensive care bereavement practices across New Zealand and Australian intensive care units: a qualitative content analysis

End-of-life and bereavement care is an important consideration in intensive care. This study describes the type of bereavement care provided in intensive care units across Australia and New Zealand. Inductive qualitative content analysis was conducted on free-text responses to a web-based survey exploring unit-based bereavement practice distributed to nurse managers in 229 intensive care units in New Zealand and Australia. A total of 153 (67%) surveys were returned with 68 respondents making free-text responses. Respondents were mainly Australian (n=54, 85·3%), from the public sector (n=51, 75%) and holding Nurse Unit Managers/Charge Nurse roles (n=39, 52·9%). From the 124 free-text responses, a total of 187 individual codes were identified focussing on bereavement care practices (n=145, 77·5%), educational provision to support staff (n=15, 8%) and organisational challenges (n=27, 14·4%). Bereavement care practices described use of memory boxes, cultural specificity, annual memorial services and use of community support services. Educational provision identified local in-service programmes, and national bereavement courses for specialist bereavement nurse coordinators. Organisational challenges focussed on lack of funding, especially for provision of bereavement follow-up. This is the first Australasian-wide survey, and one of the few international studies, describing bereavement practices within intensive care, an important aspect of nursing practice. However, with funding for new bereavement services and education for staff lacking, there are continued challenges in developing bereavement care. Given knowledge about the impact of these areas of care on bereaved family members, this requires review. Nurses remain committed to supporting bereaved families during and following death in intensive care. With limited resource to support bereavement care, intensive care nurses undertake a range of bereavement care practices at time of death, and after death through family bereavement follow-up.

Compassion-satisfaction and compassion-fatigue in Australian intensive care units

Compassion-satisfaction and compassion-fatigue in Australian intensive care units

Patient-centred nursing and compassion in Australian intensive care units: mixed methods research

Patient-centred nursing and compassion in Australian intensive care units: mixed methods research

Experiences and attitudes surrounding family participation in clinical handover in an Australian intensive care unit

Experiences and attitudes surrounding family participation in clinical handover in an Australian intensive care unit

Longevity of renal replacement filters in an Australian regional intensive care unit

Longevity of renal replacement filters in an Australian regional intensive care unit

A survey of safety culture in two Australian hospital tertiary hospital intensive care units: the SCATH-ICU study

Organisations with a strong cultural commitment to safety demonstrate an unexpectedly low rate of harmful error. Despite this, little is understood about the safety culture of Australian intensive care units (ICUs). This study aimed to evaluate the safety culture of ICUs in two tertiary hospitals in metropolitan Queensland. A cross-sectional survey was used. The 36-item Safety Attitudes Questionnaire (SAQ) was administered electronically to 522 ICU medical, nursing and allied health professionals across two sites (A and B) during January and February 2016. Data were collated into six domains of teamwork climate, safety climate, job satisfaction, stress recognition, working conditions and perceptions of management. Data were analysed using t-tests and between groups using generalising estimating equations. In total, 206 surveys were returned (39.5% response rate), with 65.5% (n=135) from Site B. Respondents included nursing (80.6%), medical (12.7%) and allied health staff (5.9%). Respondents from Site B scored all domains of the SAQ higher than those from Site A (all p<0.001). Perceptions of hospital management were poorer than those of unit management (p<0.001). Both sites demonstrated a need to improve perceptions of management and stress recognition, with other improvement priorities at Site A including job satisfaction and working conditions, and Site B being teamwork and safety climate. Variation was also found between professional groups, in the teamwork climate, working conditions and stress recognition domains (p<0.001). Despite similar governance and external structures, significant differences were found in safety culture between the two sites. This emphasises the importance of unit-level assessment and planning of improvement interventions. This study adds to the evidence that these interventions need to be unit focused, supported by management and multidisciplinary in approach.

Impact of the introduction of an endotracheal tube attachment device on the incidence of oral pressure injuries in a metropolitan Australian intensive care unit

Impact of the introduction of an endotracheal tube attachment device on the incidence of oral pressure injuries in a metropolitan Australian intensive care unit

Use of imaging studies for determination of brain death in South Australian intensive care units

Use of imaging studies for determination of brain death in South Australian intensive care units

Nurses' prioritization of enteral nutrition in intensive care units: a national survey.

Enteral nutrition is important in critically ill patients to improve patient outcomes, with nurses playing a pivotal role in the delivery and ongoing care of enteral nutrition. A significant deficit in nurses' knowledge and education relating to enteral nutrition has been identified, leading to iatrogenic malnutrition and potentially compromising patient care. Enteral nutrition appears to be prioritized lower than many other aspects of care. However, there is scant research to show how nurses prioritize enteral nutrition. This study aimed to explore how nurses prioritize enteral nutrition when caring for a critically ill patient. A descriptive online questionnaire, administered in May 2014, was utilized to explore the study aim. Descriptive statistics were performed to evaluate quantitative data. Content analysis was used to evaluate qualitative data. A total of 359 responses were included in data analysis (response rate 20.8%). All respondents were registered nurses working within an Australian intensive care unit or high dependency unit. Nurses agreed that enteral nutrition was very important and should be commenced as soon as possible. However, life-saving procedures always took priority and there were often multiple barriers that hindered optimal delivery of enteral nutrition. Respondents relied on their clinical judgement to inform decisions in relation to enteral nutrition in critically ill patients. Most respondents agreed that enteral nutrition was an important aspect of patient care, but acknowledged that other aspects of care were prioritized more highly. Despite this, some delays to enteral nutrition were perceived to be avoidable, and nurses recognized a need to advocate on the patient's behalf to increase the visibility of enteral nutrition. The findings of this study demonstrate that enteral nutrition is often prioritized lower than other competing care needs in the critically ill patient. Given the importance of enteral nutrition to patient recovery, changes to clinical practice to improve enteral nutrition management are necessary.

Low-Dose Heparin in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation - the Help-ECMO Pilot Randomised Controlled Trial

Extra corporeal membrane oxygenation (ECMO) is a rescue therapy for reversible cardiac and/or respiratory failure. Despite improvement in management of patients undergoing ECMO, mortality remains high. Due to thrombosis risk, which includes arterial and venous thrombosis as well as in the extracorporeal circuit and components, variable intensity systemic anticoagulation with unfractionated heparin is routinely used. However, bleeding is one of the most frequent complications, can be severe and is independently associated with worse outcomes. Optimal anticoagulation to prevent thrombosis whilst minimising bleeding in adults on ECMO remains unknown. Before conducting a large randomised controlled trial to determine whether lower anticoagulation intensity is safe and effective compared with therapeutic anticoagulation, we aimed to determine the feasibility of randomising ECMO patients to these anticoagulation protocols.Methods:The HELP-ECMO pilot study (ACTRN12613001324707) is a randomised, controlled, unblinded trial at two Australian intensive care units (ICUs). Inclusion criteria were ICU patients who required ECMO (venous-venous [VV] or venous-arterial [VA]). Patients who did not meet any exclusion criteria were randomised to receive either therapeutic anticoagulation with heparin (target activated partial thromboplastin time [aPTT] between 50 and 70 seconds) or low dose heparin (12000 units/24 hours aiming for aPTT <45 seconds). Paired aPTT and anti-Xa assays were taken according to protocol, and at a minimum once a day. The primary endpoints for feasibility were difference in mean heparin dose, aPTT and anti-Xa levels between both study groups. Secondary endpoints included incidence of thromboembolic events, ECMO circuit thrombosis and bleeding events. All primary outcomes were log-transformed prior to analysis and reported as geometric means (95%CI) with overall differences determined using Repeat measures ANOVA.Results:Between May 2014 and March 2016, 31 patients who underwent ECMO (9 (29%) VA and 22 (71%) VV) were enrolled; 16 were randomised to low dose and 15 to therapeutic dose heparin. The groups were similar in age (mean 41 years [SD 16.8] vs 43 [SD 17.6] p=0.75), gender (68% vs 80% male, p=0.47), type of ECMO (31% vs 27% VA, p=0.78) and Acute Physiology and Chronic Health Evaluation III illness severity score (mean 65.4 [SD 23.5] vs 61.8 [SD 30.1], p=0.72) and sepsis-related organ failure assessment score (mean 10 [SD 3.6] vs 10 [SD 3.3], p=1.0). The mean duration of ECMO support was 9.33 days (SD 5.97) in the low dose and 9.79 days (SD 4.77) in the therapeutic dose group (p=0.82).For the primary outcomes, there was a significant difference in the daily mean aPTT (48.1 [95% CI 43.5-53.3] vs 56.2 [95% CI 50.7-62.3], p=0.03), daily mean anti-Xa (0.11 [95% CI 0.07-0.18] vs 0.30 [IQR 0.19-0.46], p=0.003) and daily mean heparin dose (11784 units [95% CI 8693-15972] vs 22050 [IQR 16262-29899], p=0.004) in the low dose compared to therapeutic group.There was no difference in thrombotic complications with regard to DVT (2 [12.5%] vs 3 [20%], p=0.57), PE (1 [6.3%] vs 0 [0%], p=0.33), stroke (no events), intracardiac thrombus (1 [6.3%] vs 2 [13.3%], p=0.51), acute pump (1 [6.3%] vs 1[6.7%], p=0.96) and distal perfusion cannula thrombosis (2 [12.5%] vs 0 [0%], p=0.16) in low dose compared with therapeutic group, respectively.With regard to bleeding, there was no difference in intracranial haemorrhage (ICH) (0 [0%] vs 1 [6.7%], p=0.29), retroperitoneal bleeding (1 [6.3%] vs 1 [6.7%], p=0.96), gastrointestinal bleeding (0 [0%] vs 2 [13.3%] , p=0.13), or haemoptysis (1 [6.5%] vs 1 [6.7%], p=0.96) in low dose compared with therapeutic group, respectively.Conclusion: In this pilot trial, administration of a low dose heparin protocol was feasible, and resulted in a significant difference in mean heparin dose administered and daily aPTT and anti-Xa levels between groups. Low dose heparin was not associated with an increase in thrombotic events nor a decrease in bleeding events; however the study was not powered for these outcomes. Our findings support the feasibility of a larger phase III study to evaluate the safety and efficacy of low-dose anticoagulation compared with therapeutic heparin with regard to thrombotic and bleeding events in patients receiving ECMO. DisclosuresNo relevant conflicts of interest to declare.

Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context

BackgroundPatients admitted to Australian intensive care units are often critically unwell, and present the challenge of increasing mortality due to an ageing population. Several of these patients have terminal conditions, requiring withdrawal of active treatment and commencement of end-of-life (EOL) care. ObjectivesThe aim of the study was to explore the perspectives and experiences of physicians and nurses providing EOL care in the ICU. In particular, perceived barriers, enablers and challenges to providing EOL care were examined. MethodsAn interpretative, qualitative inquiry was selected as the methodological approach, with focus groups as the method for data collection. The study was conducted in Melbourne, Australia in a 24-bed ICU. Following ethics approval intensive care physicians and nurses were recruited to participate. Focus group discussions were discipline specific. All focus groups were audio-recorded then transcribed for thematic data analysis. ResultsFive focus groups were conducted with 11 physicians and 17 nurses participating. The themes identified are presented as barriers, enablers and challenges. Barriers include conflict between the ICU physicians and external medical teams, the availability of education and training, and environmental limitations. Enablers include collaboration and leadership during transitions of care. Challenges include communication and decision making, and expectations of the family. ConclusionsThis study emphasised that positive communication, collaboration and culture are vital to achieving safe, high quality care at EOL. Greater use of collaborative discussions between ICU clinicians is important to facilitate improved decisions about EOL care. Such collaborative discussions can assist in preparing patients and their families when transitioning from active treatment to initiation of EOL care. Another major recommendation is to implement EOL care leaders of nursing and medical backgrounds, and patient support coordinators, to encourage clinicians to communicate with other clinicians, and with family members about plans for EOL care.

Problematic Dichotomization of Risk for Intensive Care Unit (ICU)–Acquired Invasive Candidiasis: Results Using a Risk-Predictive Model to Categorize 3 Levels of Risk From a Multicenter Prospective Cohort of Australian ICU Patients

Delayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk. A prospective cohort study of 6685 consecutive nonneutropenic patients admitted to 7 Australian intensive care units (ICUs) for ≥72 hours was performed. Clinical risk factors for IC occurring prior to and following ICU admission, colonization with Candida species on surveillance cultures from 3 sites assessed twice weekly, and the occurrence of IC ≥72 hours following ICU admission or ≤72 hours following ICU discharge were measured. From these parameters, a risk-predictive model for the development of ICU-acquired IC was then derived. Ninety-six patients (1.43%) developed ICU-acquired IC. A simple summation risk-predictive model using the 10 independently significant variables associated with IC demonstrated overall moderate accuracy (area under the receiver operating characteristic curve = 0.82). No single threshold score could categorize patients into clinically useful high- and low-risk groups. However, using 2 threshold scores, 3 patient cohorts could be identified: those at high risk (score ≥6, 4.8% of total cohort, positive predictive value [PPV] 11.7%), those at low risk (score ≤2, 43.1% of total cohort, PPV 0.24%), and those at intermediate risk (score 3-5, 52.1% of total cohort, PPV 1.46%). Dichotomization of ICU patients into high- and low-risk groups for IC risk is problematic. Categorizing patients into high-, intermediate-, and low-risk groups may more efficiently target early antifungal strategies and utilization of newer diagnostic tests.

The provision of family-centred intensive care bereavement support in Australia and New Zealand: Results of a cross sectional explorative descriptive survey

BackgroundCaring for the bereaved is an intrinsic part of intensive care practice with family bereavement support an important aspect of the nursing role at end of life. However, reporting on provision of intensive care family bereavement support at a national level has not been well reported since an Australian paper published ten years ago. ObjectivesThe objective was to investigate provision of family bereavement support in intensive care units (ICU) across New Zealand (NZ) and Australia. MethodA cross-sectional exploratory descriptive web-based survey was used. All ICUs [public/private, neonatal/pediatrics/adults] were included. The survey was distributed to one nursing leader from each identified ICU (n=229; 188 in Australia, 41 in NZ). Internal validity of the survey was established through piloting. Descriptive statistics were used to analyse the data. Ethical approval was received by the ethics committees of two universities. ResultsOne-hundred and fifty-three (67%) responses were received from across New Zealand and Australia with 69.3% of respondents from the public sector. Whilst respondents reported common bereavement practices to include debriefing for staff after a traumatic death (87.9%), there was greater variation in sending a sympathy card to families (NZ 54.2%, Australia 20.8%). Fifty percent of responding New Zealand units had a bereavement follow-up service compared to 28.3% of Australian unit respondents. Of those with follow-up services, 92.3% of New Zealand units undertook follow-up calls to families compared to 76.5% of Australian units. Bereavement follow-up services were mainly managed by social workers in Australia and nursing staff in New Zealand. ConclusionsThis is the first Australia and New Zealand-wide survey on ICU bereavement support services. Whilst key components of family bereavement support remain consistent over the past decade, there were fewer bereavement follow-up services in responding Australian ICUs in 2015. As a quality improvement initiative, support for this area of family care remains important with rigorous evaluation essential.