Families In ICU Research Articles

Intensive care nurse-family engagement from a global perspective: A qualitative multi-site exploration

BackgroundCritical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. ObjectivesTo describe nurses’ perceptions and practices of family engagement in adult intensive care units from a global perspective. DesignA qualitative-descriptive multi-site design using content analysis. SettingsThe study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. ParticipantsA total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. MethodsSemi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. ResultsWe found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses’ practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses’ attitudes and perceptions of family, the patient’s condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses’ ability to engage with families. ConclusionsThis global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care.

Adapting a Traumatic Brain Injury Goals-of-Care Decision Aid for Critically Ill Patients to Intracerebral Hemorrhage and Hemispheric Acute Ischemic Stroke.

Families in the neurologic ICU urgently request goals-of-care decision support and shared decision-making tools. We recently developed a goals-of-care decision aid for surrogates of critically ill traumatic brain injury patients using a systematic development process adherent to the International Patient Decision Aid Standards. To widen its applicability, we adapted this decision aid to critically ill patients with intracerebral hemorrhage and large hemispheric acute ischemic stroke. Prospective observational study. Two academic neurologic ICUs. Twenty family members of patients in the neurologic ICU were recruited from July 2018 to October 2018. None. We reviewed the existing critically ill traumatic brain injury patients decision aid for content and changed: 1) the essential background information, 2) disease-specific terminology to "hemorrhagic stroke" and "ischemic stroke", and 3) disease-specific prognosis tailored to individual patients. We conducted acceptability and usability testing using validated scales. All three decision aids contain information from validated, disease-specific outcome prediction models, as recommended by international decision aid standards, including careful emphasis on their uncertainty. We replaced the individualizable icon arrays graphically depicting probabilities of a traumatic brain injury patient's prognosis with icon arrays visualizing intracerebral hemorrhage and hemispheric acute ischemic stroke prognostic probabilities using high-quality disease-specific data. We selected the Intracerebral Hemorrhage Score with validated 12-month outcomes, and for hemispheric acute ischemic stroke, the 12-month outcomes from landmark hemicraniectomy trials. Twenty family members participated in acceptability and usability testing (n = 11 for the intracerebral hemorrhage decision aid; n = 9 for the acute ischemic stroke decision aid). Median usage time was 22 minutes (interquartile range, 16-26 min). Usability was excellent (median System Usability Scale = 84/100 [interquartile range, 61-93; with > 68 indicating good usability]); 89% of participants graded the decision aid content as good or excellent, and greater than or equal to 90% rated it favorably for information amount, balance, and comprehensibility. We successfully adapted goals-of-care decision aids for use in surrogates of critically ill patients with intracerebral hemorrhage and hemispheric acute ischemic stroke and found excellent usability and acceptability. A feasibility trial using these decision aids is currently ongoing to further validate their acceptability and test their feasibility for use in busy neurologic ICUs.

Factors influencing integrated palliative care processes in intensive care units: a mixed methods systematic review

Introduction: Although survival is a central goal for intensive care, some patients die in the ICU or shortly after discharge. For patients with critical illnesses who may or may not survive a palliative approach is suggested to improve their quality of life and to support their families. However, we lack knowledge about adapting, integrating and adopting a palliative care approach in the ICU setting. Objectives/Aims: This review aims to identify factors influencing the integration of a palliative care approach in the ICU setting as perceived by healthcare professionals. Methods: A systematic mixed methods review was conducted and data were analysed by applying a thematic synthesis. Multiple databased were used for systematic searches with the following terms: palliative care, implementation and ICU. A total of 1843 studies were identified and screened, and 24 studies were included for this review. Results: Three key prerequisites to integrate and adopt palliative care approaches in ICU were identified that acts as enablers and barriers factors for integration and adoption of palliative care in ICU (a) family-centred care factors including patient and family involvements with care; communication; b) decision and transition including decision making; goal conflict; and (c) organisational culture including facilitating policies and guidelines, knowledge and skill, multi-disciplinary team and, environmental care. Conclusion: The outcomes provide important guidance to the development of implementation strategies for palliative care approaches in the ICU setting. Acknowledging the enabling yet hindering prerequisite of family-centred care, decision and transition of goal and organisational culture are important for implementing palliative care approaches into ICU settings. Training and education are important for healthcare professionals and mangers to ensure that hindering factors are successfully solved and palliative care provided to all patients and families in ICU.

Reasons why of nurses empaty with newborn families in neonatal ICU.

To understand the empathic conduct and the reasons why nurses empathize with relatives of newborns in a Neonatal Intensive Care Unit. Phenomenological research, performed in a hospital in Mato Grosso, Brazil. Data were collected between May and August 2018, through interviews with 11 nurses experienced in neonatal care, and analyzed through the lens of Alfred Schutz's Social Phenomenology. Presented by two categories: nurses' empathy with family members of newborns in Neonatal ICU: empathic conduct; and, the reasons why the empathic conduct of nurses with family members in neonatal ICU. Empathy occurred centrally with the mother of newborns, expressed in communication, identification and construction of bonds. The reasons why the nurses' personal experiences are linked to motherhood, grief and suffering.

Organ donation education in the ICU setting: a qualitative and quantitative analysis of family preferences

PurposeDetermine family-centered methods of providing organ donation education to families in ICU waiting rooms. Materials and methodsWe performed a qualitative analysis of semi-structured interviews and quantitative analysis of paper surveys of family members of 118 ICU patients in the acute ICU setting. ResultsTwelve interviews and 152 surveys (66% response rate) were completed. Respondents' knowledge of organ donation processes was incomplete: only 32% answered all of four questions about donation correctly. No significant correlation was found between respondents' objective knowledge scores and their self-reported donation knowledge (ρ = 0.07, p = .46). Seventy-five percent of respondents (110/147) thought receiving donation information during the ICU stay would aid their decision-making regarding donation. The most preferred methods of receiving information were via a website link (94% positive or neutral response) or brochures in the waiting room (89% positive or neutral), while the least preferred methods were having brochures in the ICU admission packet (24% negative) and a poster in the ICU waiting room (22% negative). ConclusionsICU families desire accurate information about organ donation, and are receptive to its provision in the acute ICU setting. Family-centered approaches to information delivery may enhance understanding of organ donation processes and aid decision-making about organ donation.

Constructing the story: How nurses work with families regarding withdrawal of aggressive treatment in ICU – A narrative study.

Specific communication practices used by experienced intensive care nurses who are comfortable working with dying patients and their families in ICU to reach consensus on withdrawal of aggressive treatment and shift to palliative care are lacking in the literature. However, there are seven international qualitative studies relevant to this research. Important themes related to communication were composed of four elements: general communication and relationship building, recognizing the need to transition to palliative care, facilitating palliative care, and providing dignified care through to death. To describe the specific communication practices experienced intensive care nurses' comfortable working with dying patients' use with families to negotiate consensus on withdrawal of aggressive treatment and/or shift to palliative are at end of life. A qualitative narrative study. Purposeful sampling was used to recruit nineteen experienced intensive care nurses. A narrative approach was used for data collection and analysis. Consistent with narrative inquiry the results describe an overall plot: "constructing the story" and five subplots that identify and describe communicative actions relevant to the plot. The five subplots are: (A) organizing and interpreting knowledge of different kinds from different sources; (B) learning who the patient is as a person and putting the medical diagnosis into the biographical life of the patient; (C) helping families see the deteriorating status of the patient; (D) imagining and acting on moral possibilities for end of life care; and (E) facilitating saying goodbye – the end of the story. Findings from this study enrich the understanding of how experienced nurses who are comfortable with dying patients communicate with families as they navigate the difficult path of transitioning from aggressive care to palliative care for their significant other in the intensive care unit. This research provides a beginning language that can enable caregivers to talk about and reflect on the complex communication necessary for good end of life care. The findings of this study have major implications for clinical practice and interdisciplinary education.

Nurses caring for dying patients and their families in paediatric and neonatal ICU: A linguistic inquiry approach

Nurses caring for dying patients and their families in paediatric and neonatal ICU: A linguistic inquiry approach

救急外来とICUで死別を体験した家族の複雑性悲嘆：一般病棟との比較

救急外来とICUで死別を体験した家族の複雑性悲嘆：一般病棟との比較

Research of mental disorder in family members of patients and intervention strategies in cardiovascular surgical ICU

Objective To investigate the mental state of ICU patients' families, analyze related factors, research on prevention and intervention measures.Methods 100 families in cardiac surgery ICU were investigated by questionnaire (SCL-90), and SPSS 15.0 software was used in data entry, statistics and analysis.Results In this survey, 100 cases samples according to the total proceeds are divided into SCL-90 (173.46±0.87), higher than the national norm of (160.00±0.87),the difference was statistically significant(t=2.500,P<0.05). Study objects were prevalence in anxiety, depression, somatization, etc.the difference was statistically significant(t=2.298,2.522,3.128,2.801,6.379;P<0.05 or P<0.01).Conclusions Family members of ICU patients outside were in anxiety, depression, somatization, and other psychological problems. Heart-ICU nurse at work should be strengthened in ICU patients' relatives of psychological support, information support and community support. Key words: Intensive care; Mental health; Family members of patients

The future of families in ICU—The positive effects of partnering with families

THE FUTURE OF FAMILIES IN ICU - THE POSITIVE EFFECTS OF PARTNERING WITH FAMILIES Marion L. Mitchell1, Wendy Chaboyer1, Liz Burmeister2, Michelle Foster3 1School of Nursing and Midwifery, Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Australia; 2 ICU, Princess Alexandra Hospital, Brisbane, Australia; 3ICU, Gold Coast Hospital, Southport, Australia. Generally, families are not actively involved in ICU patients' care in meaningful ways. A Family-Centred-Care (FCC) model formalises the family and patient as the unit of care. FCC is comprised of three concepts - respect, collaboration and support. This study evaluated the effects on FCC of ICU nurses partnering with families to provide fundamental care. A pre-test, post-test design was used with families at the control site experiencing usual conditions whereas those at the intervention site were invited to assist with their relative's care. All participants provided written consent. The FCC survey measured families' perceptions of respect, collaboration and support at baseline and then 48 hours. A total of 174 family members participated (75 control, 99 intervention). Total FCC sores at baseline were 3.19 (control) and 3.39 (intervention) and at follow-up were 3.18 (control) and 3.46 (intervention) (range1-5). Multivariate logistic regression identified independent predictors of FCC scores. After pre-test score, the FCC intervention was the strongest predictor of post-test score. Other predictors included when the patient was female and the patient's partner (Table 1). This study indicates that ICU nurses partnering with family members to provide fundamental care significantly improved family's perceptions of respect, collaboration and support. FCC provides a model for future improvements to families' experience of ICU. TABLE 1: Predictors of Post-test FCC Survey Total FCC Variable (reference group) OR (95% CI) p Pre-test score 5.48 (4.9-6.12) <.001 Group (control ) 1.66 (1.4-1.97) <.001 Patient Gender (male) 1.48 (1.21-1.80) <.001 Partner 1.33 (1.11-1.58) 0.002 ICU Experience 1.27 (1.07-1.50) 0.006

The future of families in ICU—The positive effects of partnering with families

Prize of $2,500 sponsored by Eli Lilly

Families in the ICU: do we truly consider their needs, experiences and satisfaction?

Families in the ICU: do we truly consider their needs, experiences and satisfaction?