Patient- and Family-Centered Care: First Steps on a Long Journey

Sevransky, J. (2017) Critical Care Medicine. 45(5) pp. 757–758

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ICUs are among the most intimidating locations in the hospital for patients and families. Some machines are connected to the surface. Others invade the substance of the body. Life-sustaining devices and their connections often impair communication and performance of the activities of daily life. Even professionals-turned patients have difficulties communicating effectively when on the other side of the stethoscope (1) in an ICU.

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Patient and Family Engagement in the Organization of Critical Care

Haines, K.J.et al. (2017) Critical Care Medicine: 45(5) pp. 899–906

Objective: There is growing interest in patient and family participation in critical care—not just as part of the bedside, but as part of educational and management organization and infrastructure. This offers tremendous opportunities for change but carries risk to patients, families, and the institution. The objective is to provide a concise definitive review of patient and family organizational participation in critical care as a high-risk population and other vulnerable groups. A pragmatic, codesigned model for critical care is offered as a suggested approach for clinicians, researchers, and policy-makers.

Conclusions: A model of patient and family engagement in critical care does not exist, and we propose a pragmatic, codesigned model that takes into account issues of psychologic safety in this population. Significant opportunity exists to document processes of engagement that reflect a changing paradigm of healthcare delivery.

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Implementing EBP: in-hospital family-witnessed cardiopulmonary resuscitation

Sak-Dankosky, N. Nursing in Critical Care. Published online: 9 April 2017

Background: In-hospital, family-witnessed cardiopulmonary resuscitation of adults has been found to help patients’ family members deal with the short- and long-term emotional consequences of resuscitation. Because of its benefits, many national and international nursing and medical organizations officially recommend this practice. Research, however, shows that family-witnessed resuscitation is not widely implemented in clinical practice, and health care professionals generally do not favour this recommendation.

Conclusion: Despite existing evidence revealing the positive influence of family-witnessed resuscitation on patients, relatives and cardiopulmonary resuscitation process, Finnish and Polish health care providers cited a number of personal and organizational barriers against this practice. The results of this study begin to examine reasons why family-witnessed resuscitation has not been widely implemented in practice. In order to successfully apply current evidence-based resuscitation guidelines, provider concerns need to be addressed through educational and organizational changes.

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A Nursing Intervention for Improving Patient Safety in Critical Care

Pfrimmer, D.M. et al. (2017) Dimensions of Critical Care Nursing36(1) pp. 45–52

11556-2Background: Nursing surveillance has been identified as a key intervention in early recognition and prevention of errors/adverse events. Nursing Intervention Classification (NIC) defines surveillance as “the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making.” Because nurses are the main staffing constant in the critical care environment, the importance of surveillance as an intervention is fundamental.

Discussion: Surveillance was expressed through nurses’ gathering cues, reflecting on past knowledge, asking questions, verifying, and pulling it all together to find meaning. During handoff, surveillance involved collaborative cognitive work to find meaning in cues.

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Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs.

Wysham, N. et al. Critical Care Medicine. Published online: 9 September 2016

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Image source: PROFrancis Bijl – Flickr // CC BY 2.0

Objective: Addressing the quality gap in ICU-based palliative care is limited by uncertainty about acceptable models of collaborative specialist and generalist care. Therefore, we characterized the attitudes of physicians and nurses about palliative care delivery in an ICU environment.

Design: Mixed-methods study.

Setting: Medical and surgical ICUs at three large academic hospitals.

Participants: Three hundred three nurses, intensivists, and advanced practice providers.

Measurements and Main Results: Clinicians completed written surveys that assessed attitudes about specialist palliative care presence and integration into the ICU setting, as well as acceptability of 23 published palliative care prompts (triggers) for specialist consultation. Most (n = 225; 75%) reported that palliative care consultation was underutilized. Prompting consideration of eligibility for specialist consultation by electronic health record searches for triggers was most preferred (n = 123; 41%); only 17 of them (6%) felt current processes were adequate. The most acceptable specialist triggers were metastatic malignancy, unrealistic goals of care, end of life decision making, and persistent organ failure. Advanced age, length of stay, and duration of life support were the least acceptable. Screening led by either specialists or ICU teams was equally preferred. Central themes derived from qualitative analysis of 65 written responses to open-ended items included concerns about the roles of physicians and nurses, implementation, and impact on ICU team-family relationships.

Conclusions: Integration of palliative care specialists in the ICU is broadly acceptable and desired. However, the most commonly used current triggers for prompting specialist consultation were among the least well accepted, while more favorable triggers are difficult to abstract from electronic health record systems. There is also disagreement about the role of ICU nurses in palliative care delivery. These findings provide important guidance to the development of collaborative care models for the ICU setting.

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