The Impact of Social Support Networks on Family Resilience in an Australian Intensive Care Unit: A Constructivist Grounded Theory.

This article by Wong and colleagues was published in the Journal of Nursing Scholarship during November 2018.
Purpose:  This article discusses the findings of a grounded theory of family resilience in an Australian intensive care unit (ICU) with a specific focus on families’experiences of their interactions with other members within their own family,and the families of other patients in the ICU.
Design:  A constructivist grounded theory methodology was adopted. Data were collected using in-depth interviews with 25 family members of 21 critically ill patients admitted to a tertiary-level ICU in Australia.
Findings:  The core category regaining control represents the families’ journey toward resilience when in ICU. The major categories represent facilitators for, and barriers to,regaining control. One of the main facilitators is drawing strength, and it explains the manner with which families receive social support from their own and other family members to help them cope.
Conclusions:  This study offers a framework to improve patient- and family-centered care in the ICU by facilitating families’ ability to manage their situation more effectively.Social support offered by family members facilitates the families’ ability to regain control. An ICU family resilience theoretical framework, situated within the context of the Australian healthcare system, adds to what is currently known about the families’ experiences in the ICU.
Clinical Relevance: The relationships that develop between families in the ICU may provide a source of social support; however, not all families welcome interactions with other ICU families, and it may cause further emotional distress. Further research is warranted to determine whether families suffer a secondary stress reaction from incidental interactions with other patients’ families in the ICU.Furthermore, when family members pull together and offer social support to each other, they are better able to regain control. This process contributes to an ICU family resilience framework.
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Strengthening workplace well-being: perceptions of intensive care nurses

This article by Jarden et al was published in the September 2018 issue of Nursing in Critical Care.
Background:  Intensive care nursing is a professionally challenging role, elucidated in the body of research focusing on nurses’ ill-being, including burnout, stress, moral distress and compassion fatigue. Although scant, research is growing in relation to the elements contributing to critical care nurses’ workplace well-being. Little is currently known about how intensive care nurse well-being is strengthened in the workplace, particularly from the intensive care nurse perspective.
Aims and Objectives:  Identify intensive care nurses’ perspectives of strategies that strengthen their workplace well-being.
Design:  An inductive descriptive qualitative approach was used to explore intensive care nurses’ perspectives of strengthening work well-being.
Method:  New Zealand intensive care nurses were asked to report strategies strengthening their workplace well-being in two free-text response items within a larger online survey of well-being.
Findings:  Sixty-five intensive care nurses identified 69 unique strengtheners of workplace well-being. Strengtheners included nurses drawing from personal resources, such as mindfulness and yoga. Both relational and organizational systems’ strengtheners were also evident, including peer supervision, formal debriefing and working as a team to support each other.
Conclusions:  Strengtheners of intensive care nurses’ workplace well-being extended across individual, relational and organizational resources. Actions such as simplifying their lives, giving and receiving team support and accessing employee assistance programmes were just a few of the intensive care nurses’ identified strengtheners. These findings inform future strategic workplace well-being programmes, creating opportunities for positive change.
Relevance to clinical practice:  Intensive care nurses have a highly developed understanding of workplace well-being strengtheners. These strengtheners extend from the personal to inter-professional to organizational. The extensive range of strengtheners the nurses have identified provides a rich source for the development of future workplace well-being programmes for critical care.
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Ward visits- one essential step in intensive care follow-up. An interview study with critical care nurses’ and ward nurses’.

This article was published in “Intensive and Critical Care Nursing” September 2018 issue by Haggstrom and colleagues.
Objective:  The aim of this study was to describe critical care nurses’ and ward nurses’ perceptions of the benefits and challenges with a nurse-led follow-up service for intensive care-survivors at general wards.
Background:  Patients recently transferred from intensive care to the general ward are still vulnerable and require complex care. There are different models of intensive care follow-up services and some include ward visits after transfer from intensive care. Research methodology/design: This study had a qualitative design. Data from 13 semi-structured interviews with Swedish critical care nurses and ward nurses were analysed using qualitative content analysis.
Findings:  The findings consisted of one theme, namely, “Being a part of an intra-organisational collaboration for improved quality of care”, and four subthemes: “Provides additional care for the vulnerable patients, “Strengthens ward-based critical care”, “Requires coordination and information”, and “Creates an exchange of knowledge”. The nurse-led follow-up service detected signs of deterioration and led to better quality of care. However, shortage of time, lack of interaction, feedback and information about the function of the follow-up service led to problems.
Conclusion:  The findings indicate that ward visits should be included in the intensive care follow-up service. Furthermore, intra-organisational collaboration seems to be essential for intensive care survivors’ quality of care.
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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.
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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.
The full text of this article is available via the PDF that can be accessed via this link