Interprofessional Collaborative Practice in the Medical Intensive Care Unit: a Survey of Caregivers’ Perspectives.

This article was published in Journal of General Internal Medicine in August 2018 by Chen and colleagues.
Background:  Research on caregivers, defined as designated family members or support persons, in the medical intensive care unit (MICU) has primarily focused on their emotional needs and experiences, thus leaving a gap in knowledge related to their perceptions of team dynamics.
Objective:  To examine caregivers’ perceptions of team interactions and competencies for interprofessional collaborative practice (IPCP) and overall satisfaction with the MICU team.
Methods:  The Support Person Jefferson Teamwork Observation Guide (JTOG)™ was administered to a convenience sample of caregivers in the MICU at a large urban academic medical center between May 2016 and December 2016.
Results:  One hundred sixty-one JTOG surveys were completed. Caregivers agreed on the importance of healthcare professionals working together as a team to provide patient care (3.97 out of 4.0 on Likert response scale where 1 is “Not at all important” and 4 is ‘Extremely important”) and were satisfied with the MICU team (3.74 out of 4.0), positively evaluating the four core competencies for IPCP (3.55 for values/ethics, 3.58 for interprofessional communication, 3.61 for roles/responsibilities, and 3.64 for teams/teamwork) and the patient/family-centeredness sub-competency (3.58 out of 4.0). There was a strong positive correlation between caregivers’ Global JTOG scores and overall satisfaction with the MICU team (r = 0.596, p < 0.01). Caregivers’ comments about factors that affected their experience focused on aspects of interprofessional communication and patient/family-centeredness.
Conclusion:  Findings underscore the importance of interprofessional communication and providing patient/family-centered care. Assessing caregivers’ perceptions of IPCP can provide a critical lens into team functioning and, thus, be used to identify teams’ strengths as well as opportunities for improvement.
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Attention-seeking actions by patients on mechanical ventilation in intensive care units: A qualitative study

This article by Wallander was published in the July 2018 issue of the Journal of Clinical Nursing.
Aims and Objectives:  The aim of this study was to explore the interaction between mechanically ventilated patients and healthcare personnel in intensive care units, with a special emphasis on patients’ initiative to communicate.
Background:  Patients on mechanical ventilation in intensive care units tend to be less sedated today compared to standard care in the past. Their experiences of being voiceless may cause emotional distress, and for many patients, communication is difficult. Healthcare personnel are reported to be the main initiators of the communication exchanges that occur.
Design:  An observational study with a phenomenological-hermeneutical approach.
Methods:  Video recording was used to collect data on the naturally occurring communication and interaction. Ten conscious and alert patients from two Norwegian intensive care units were recruited. Two relatives and a total of sixty healthcare personnel participated. Content analysis was conducted, with focus on both the manifest and latent content meaning.
Results:  We found a total of 66 situations in which patients attempted to attract the attention of others on their own initiative in order to express themselves. Attention-seeking actions, defined as the act of seeking attention and understanding without a voice, became an essential theme. Four patterns of interaction were identified: immediately responded to, delayed response or understanding, intensified attempts, or giving up. Patients had a variety of reasons for seeking attention, which were classified into four domains: psychological expressions, physical expressions, social expressions, and medical treatment.
Conclusions:  Patients’ attention-seeking actions varied in content, form, and the types of responses they elicited. The patients had to fight to first gain joint attention and then joint understanding. This was both energy draining and time consuming.
Relevance to Clinical Practice:  Healthcare personnel need to spend more time for communication purposes, giving attention and being more alert to bodily or symbolic gestures to understand the patient’s needs. This article is protected by copyright. All rights reserved.
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Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study

This article by de Grood and colleagues was published in the June 2018 issue of the Canadian Medical Association Journal.
Background:  Transfer of patient care from an intensive care unit (ICU) to a hospital ward is often challenging, high risk and inefficient. We assessed patient and provider perspectives on barriers and facilitators to high-quality transfers and recommendations to improve the transfer process.
Methods:  We conducted semi-structured interviews of participants from a multicentre prospective cohort study of ICU transfers conducted at 10 hospitals across Canada. We purposively sampled 1 patient, 1 family member of a patient, 1 ICU provider, and 1 ward provider at each of the 8 English-speaking sites. Qualitative content analysis was used to derive themes, subthemes and recommendations.
Results:  The 35 participants described 3 interrelated, overarching themes perceived as barriers or facilitators to high-quality patient transfers: resource availability, communication and institutional culture. Common recommendations suggested to improve ICU transfers included implementing standardized communication tools that streamline provider-provider and provider-patient communication, using multimodal communication to facilitate timely, accurate, durable and mutually reinforcing information transfer; and developing procedures to manage delays in transfer to ensure continuity of care for patients in the ICU waiting for a hospital ward bed.
Interpretation:  Patient and provider perspectives attribute breakdown of ICU-to-ward transfers of care to resource availability, communication and institutional culture. Patients and providers recommend standardized, multimodal communication and transfer procedures to improve quality of care.
The full text of this article is freely available from the journal’s homepage via this link.

A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses

This article by Hetland et al was published in the February 2018 issue of “Intensive and critical care nursing”.
Objective:  Family caregiver involvement may improve patient and family outcomes in the intensive care unit. This study describes critical care nurses’ approaches to involving family caregivers in direct patient care.
Research Methodology and Design:  This is a qualitative content analysis of text captured through an electronic survey.
Setting:  A convenience sample of 374 critical care nurses in the United States who were subscribers to one of the American Association of Critical Care Nurses social media sites or electronic newsletters.
Main Outcome Measure:  Critical care nurses’ responses to five open-ended questions about their approaches to family involvement in direct patient care.
Findings:  Nurse, patient and family caregiver factors intersected in the context of the professional practice environment and the available resources for family care. Two main themes were identified: “Involving family caregivers in patient care in the intensive care unit requires careful assessment” and “There are barriers and facilitators to caregiver involvement in patient care in the intensive care unit.”
Conclusion:  Patient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research.
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Ward nurses’ experiences of the discharge process between intensive care unit and general ward

This piece of qualitative research by Kauppi, Proos and Olausson was published in the January 2018 issue of Nursing in Critical Care.

Background:  Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step-down unit.

Aims and Objectives:  The aim of this study was to explore general ward nurses’ experiences of caring for patients being discharged from an ICU.

Design and Methods:  Data were collected from focus groups and in-depth interviews with a total of 16 nurses from three different hospitals in Sweden. An inductive qualitative design was chosen.

Findings:  The analysis revealed three themes that reflect the challenges in nursing former ICU patients: a vulnerable patient, nurses’ powerlessness and organizational structure. The nurses described the challenge of nursing a fragile patient based on several aspects. They expressed feeling unrealistic demands when caring for a fragile former ICU patient. The demands were related to their own profession and knowledge regarding how to care for this group of patients. The organizational structure had an impact on how the nurses’ caring practice could be realized. This evoked ethical concerns that the nurses had to cope with as the organization’s care guidelines did not always favour the patients.

Conclusions:  The structure of the organization and its leadership appear to have a significant impact on the nurses’ ability to offer patients the care they need.

Relevance to Clinical Practice:  This study sheds light on the need for extended outreach services and intermediate care in order to meet the needs of patients after the intensive care period.

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

This article by Coombs et al was published in Journal of Clinical Nursing October 2017 issue.
Background:  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.
Design:  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.
Results:  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.
Conclusions:  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.
Relevance to Clinical Practice:  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.
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Evaluating the past to improve the future – A qualitative study of ICU patients’ experiences.

This article was published in “Intensive and Critical Care Nursing” by Olsen et al in September 2017

Background:  The recovery period for patients who have been in an intensive care units often prolonged and suboptimal. Anxiety, depression and post-traumatic stress disorder are common psychological problems. Intensive care staff offer various types of intensive aftercare. Intensive care follow-up aftercare services are not standard clinical practice in Norway.

Objectives:  The overall aim of this study is to investigate how adult patients experience the intensive care stay their recovery period, and the usefulness of an information pamphlet.

Method:  A qualitative, exploratory research with semi-structured interviews of 29 survivors after discharge from intensive care and three months after discharge from the hospital.

Results:  Two main themes emerged: “Being on an unreal, strange journey” and “Balancing between who I was and who I am” Patients’ recollection of their intensive care stay differed greatly. Continuity of care and the nurse’s ability to see and value individual differences was highlighted. The information pamphlet helped intensive care survivors understand that what they went through was normal.

Conclusions:  Continuity of care and an individual approach is crucial to meet patients’ uniqueness and different coping mechanisms. Intensive care survivors and their families must be included when information material and rehabilitation programs are designed and evaluated.

 

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