Open visiting in adult intensive care units – A structured literature review

BackgroundOpen visitation in adult intensive care units report benefits such as reduced frequency and duration of deliriums, improved patient and family satisfaction, and reduced anxiety and depression of family members. ‘Being close’ is one of the most basic and important needs of family members of critically ill patients. Open visitation provides an increased opportunity of being at the bedside with the patient, however, it is not universally embraced by adult intensive care units worldwide.AimTo critically appraise the literature concerning open visitation in adult intensive care units.DesignA structured literature review.MethodThis review was guided by the methodology by Kable et al. (2012). Sixteen articles are included in the review.ResultsDespite the documented benefits, several challenges exist which hinder broad application of open visitation in adult intensive care units.ConclusionThis review acknowledged challenges faced in adopting an open visiting policy in adult intensive care units such as negative staff perceptions and attitudes; patient protection; family and cultural consideration, as well as organisational challenges. The lack of a clear and consistent definition of open visitation is problematic, and strategies are urgently needed to support staff to provide holistic patient- and family-centred care.     

La visita flexible en las unidades de cuidados intensivos: beneficios para los familiares del paciente crítico

AimTo identify, analyze and summarize the main effects that may be related to flexible visitation policies for the relatives of critically ill adults.MethodA review of the literature was conducted in the following databases: PubMed, CINAHL, PsycINFO, Cochrane Library and CUIDEN. Thematic content analysis was used to evaluate selected articles.ResultsFifteen articles were included in this review. Four main themes emerged from the thematic content analysis. Themes included the main effects of flexible visitation policies for the family of the critical patients such as: improvement of satisfaction, reduction of anxiety and stress, satisfaction regarding their own family needs, and the role of the family in the patient's care.ConclusionAccording to the existing evidence, flexible visitation policies appear to be both beneficial and decisive. It seems to be necessary to favor the participation of the family in the care of the intensive patient as well as the acquisition of a more prominent role the visitation context and in their relationship with the patient.     

The social integration of healthcare agency workers in long-term care facilities: A cross-sectional study

BackgroundPatient care quality is a key concern for long-term care facilities and is directly related to effective collaboration between healthcare professionals. The use of agency staff in long-term care facilities creates important challenges in terms of coordination and communication within work units.ObjectivesThe purpose of this study is to assess the mediating effect of common in-group identity in the relationship between permanent employees’ perceptions regarding the use of agency workers -namely distributive justice, perceptions of threat, perceived similarities with agency workers, and leader inclusiveness toward agency staff- and the permanent employees’ adoption of collaborative behaviours.DesignCross-sectional study.SettingsThree long-term care facilities.Participants290 regular healthcare employees (nurses and care attendants).MethodsData were obtained through questionnaires filled out by employees. Hypotheses were tested using structural equation analyses.ResultsThe results showed the indirect effects of perceived distributive justice, perceived similarity and leader inclusiveness toward agency workers on permanent employees’ cooperation behaviours through common group identification. Perceptions of threat were not related to common group identification or collaborative behaviours. The results also showed that common in-group identification is related to cooperation behaviours only for employees without previous experience as agency workers.ConclusionsThis study suggests that permanent healthcare employees who feel they are fairly compensated relative to agency workers, who consider these workers as similar to them, and who believe their supervisor appreciates agency workers’ contributions tend to develop a common in-group identity, which fosters collaborative behaviours. Managers of long-term care facilities who wish to foster collaboration among their blended workforce should thus create an environment conducive of a more inclusive identity, particularly if their employees have no previous experience as agency workers.     

“I Didn’t Know Massages Could Do That:” A qualitative analysis of the perception of hospitalized patients receiving massage therapy from specially trained massage therapists

ObjectiveThis study examined the perception and experience of hospitalized palliative care eligible patients receiving massage therapy from specially trained massaged therapist.DesignTwenty hospitalized palliative care eligible patients received three differing doses of massage therapy from specially trained massage therapists. Patients were interviewed about their experience and perception related to the massage. Open-ended data were collected and analyzed using a grounded theory approach.Setting912-bed tertiary hospital center in Washington, DC.ResultsParticipants generally perceived the hospital-based massage experience positively. Participants noted how the massage experience provoked reflection on the overall hospital experience in two ways: first, as a reference point to the inpatient environment itself, and second, in terms of how massage reduces this distress and creates a sense of peace, at least temporarily.ConclusionThe data collected in these semi-structured interviews showed that massage therapy can uniquely ameliorate some of the most pervasive challenges to quality of life for hospitalized patients affected by chronic and serious illness.     

Inpatient Rehabilitation Quality of Care From the Patient’s Perspective: Effect of Data Collection Timing and Patient Characteristics

ObjectiveTo compare, by collection time and patient characteristics, inpatient rehabilitation quality measure scores calculated using patient-reported data.DesignCohort study of rehabilitation inpatients with neurologic conditions who reported their experience of care and pain status at discharge and 1month after discharge.SettingTwo inpatient rehabilitation facilities (IRFs).ParticipantsPatients with neurologic conditions (N=391).InterventionsNot applicable.Main Outcome MeasuresWe calculated 18 quality measure scores using participants’ responses to 55 experience of care and health status questions addressing communication, support and encouragement, care coordination, discharge information, goals, new medications, responsiveness of staff, cleanliness, quietness, pain management, care transitions, overall hospital rating, willingness to recommend, and pain.ResultsOf the 391 participants reporting at discharge, 277 (71%) also reported postdischarge after multiple attempts by e-mail, mail, and telephone. Discharge experience of care quality scores ranged from 25% (responsiveness of hospital staff) to 75% (willingness to recommend hospital); corresponding postdischarge scores were 32% to 87%, respectively. Five of the 16 experience of care quality scores increased significantly between discharge and postdischarge. The percentage of participants reporting high pain levels at discharge did not change across time periods. Patients with less education, older age, higher motor and cognitive function, and those who were not Hispanic or black had more favorable quality measure scores.ConclusionPatients’ experience of care responses tended to be more favorable after discharge compared to discharge, suggesting that survey timing is important. Responses were more favorable for patients with selected characteristics, suggesting the possible need for risk adjustment if patient-reported quality measure scores are compared across IRFs.     

Managing a Dual Diagnosis of Cancer and Dementia in an Acute Setting: Considerations,Implications, and Future Recommendations

ObjectivesTo present an overview of the issues related to the well-being of people affected by cancer and dementia. To highlight the evidence from dementia care that can help improve the care experiences of people with dementia and cancer.Data SourcesElectronic databases such as PubMed and CINAHL were used to retrieve relevant literature published between 2010 and 2020.ConclusionHaving a dual diagnosis of dementia and cancer poses several challenges across the cancer care pathway. Communication, treatment decision-making, environment ,and time-related issues were all identified. The literature suggests the need for evidence-based guidelines taking into consideration the person and the environment to support this population.Implications for Nursing PracticeTo address these challenges and offer an optimal care experience for this group and their families, solutions need to focus both on the workforce and the environment. Offering dementia education for professionals working in acute cancer care, as well as adapting local environments that facilitate people navigate the space can be a starting point to offer person-centered, rights-based dementia sensitive care.     

Virtual visitation in the NICU: A scoping literature review

ObjectiveThis scoping literature review aims to identify how virtual visitation (VV) is currently being used in the Neonatal Intensive Care Unit (NICU), with a specific focus on the experiences and perceptions of parents and neonatal nurses, as well as research gaps.MethodGuided by the Joanna Briggs Institute method for conducting a scoping literature review, the PubMed, CINAHL, and Web of Science databases were utilized to identify articles answering the research questions. Gray literature was also identified through ProQuest, and the home websites of the two largest commercial virtual visitation vendors were explored for additional relevant information.ResultsFollowing a comprehensive search, 12 articles were identified for inclusion in this scoping literature review. Overall, parents report positive experiences with VV, welcoming this technology in connecting to their infant. The experiences and perceptions of NICU nurses regarding the addition of VV to their practice environment are generally negative. With a paucity of research exploring the questions guiding this scoping review, research gaps are evident.ConclusionVirtual visitation in the NICU aids in connecting parents to their hospitalized infants. However, published literature reveals significant differences in the experiences and perceptions of parents and neonatal nurses for the use of VV in the NICU. Further research is warranted to understand the impact of VV in this specialized environment fully.     

Implementation and sustainment strategies for open visitation in the intensive care unit: A multicentre qualitative study

ObjectiveOpen visitation in adult intensive care units has been associated with improved family and patient outcomes. However, worldwide adoption of this practice has been slow and reasons for this are unclear. This study documents barriers and strategies for implementing and sustaining open visitation in adult intensive care units in the United States experienced by nursing leadership.Research designQualitative approach using grounded theory.ParticipantsNurse leaders in adult intensive care units with open visitation.SettingMagnet® or Pathway to Excellence® designated hospitals in the United States.MethodsSemi structured interviews were conducted with 19 nurse leaders from 15 geographically dispersed hospitals. Interviews were recorded, transcribed and imported into Atlas.ti qualitative software for analysis. Grounded theory constant comparison analysis was used for coding and category development.FindingsThe analysis revealed three barriers; nursing attitudes and clinical and nonclinical barriers. Strategies to overcome these barriers were empathy, evidence-based practice, models of care, shared governance, nurse discretion, security and family spaces.ConclusionIntensive care nursing leadership experienced distinct barriers and strategies during pre-implementation, implementation and sustainment of open visitation. Other nursing leaders interested in open visitation can use these findings as they plan this transition in their intensive care units.     

The effect of video visitation on intensive care unit patients and family members outcomes during the COVID-19 pandemic: A randomised controlled trial

ObjectiveTo investigate the effect of video visitation on intensive care patients’ and family members’ outcomes during the COVID-19 pandemic.DesignThis is a randomised controlled trial.SettingAn adult intensive care unit in a tertiary hospital in Beijing, China.MethodsA total of 121 adults, who were >18 years of age, conscious, able to communicate verbally, and admitted to the intensive care unit for over 24 hours were randomised into the intervention (video visitation) (n = 65) and control (n = 56) Groups. A total of 98 family members participated. Patient primary outcomes included anxiety and depression, measured using the Hospital Anxiety and Depression Scale. Secondary outcomes included patient delirium and family anxiety assessed using the Confusion Assessment Method scale and Self-Rating Anxiety Scale, respectively; and patient and family satisfaction, measured using a questionnaire routinely used in the hospital.ResultsThere were no statistically significant differences between the groups in patients’ anxiety (t = 1.328, p = 0.187) and depression scores (t = 1.569, p = 0.119); and no statistically significant differences in delirium incidence between the groups (7.7 % vs 7.1 %, p > 0.05). There were no significant differences in changes in family members’ anxiety scores (t = 0.496, p = 0.621). A statistically significant difference in satisfaction was found between the two group patients (86.1 % vs 57.2 % of patients were satisfied with using video visitation, p < 0.05), and the result of family members’ satisfaction was also statistically significant (88 % vs 62.5 % of family members were satisfied with using video visitation, p < 0.05).ConclusionVideo visitation did not seem to influence anxiety, but the use of video visitation can improve the patient and their family members’ satisfaction. Future research is needed to determine the feasibility of embedding video visitation into routine practice, and the optimal frequency and length of video visitation in relation to patients’ and family members’ outcomes.Implications for clinical practiceVideo visitation improved patient and family members' satisfaction. Therefore, clinicians should consider using video visitation when face to face visit is restricted. Video visVitation did not reduce patient anxiety significantly in this study maybe because the average length of intensive care stay was too short. Future research is needed on its effect on long term intensive care patients.     

The lived experience by patients and family members of extracorporeal membrane oxygenation: A qualitative study

ObjectiveTo examine the lived experience of extracorporeal membrane oxygenation (ECMO) by patients and their families, and their relationship with intensive care clinicians.Research methodologySemi-structured interviews were conducted with six patients who had received ECMO and with four of their family members. The data were analysed narratively using a constant comparative method.SettingPatients were treated at a major acute care hospital in British Columbia between 2014 and 2021. ECMO was used either as a bridge to recovery or to organ transplant. Four had family members bedside throughout, while two had virtual visits due to COVID-19 infection control measures.FindingsECMO was experienced through a triad of relationships between the patient, key family members and key clinicians. The strength, directionality and focus of these relationships shifted during therapy and realigned once ECMO was removed. The largest shift involved family members. Post-ECMO, patients relied almost entirely on spouses, adult children and clinical team members to reconstruct their experience. The connection between families and clinical team members was limited and changed little.ConclusionsThe lived experience of ECMO was complex in ways yet to be comprehensively reported in the literature. This technology had particular impact on family members when ECMO was used as a bridge to transplant and where run times extended to multiple weeks. COVID-19 infection control restrictions further complicated how this technology was experienced. Findings from this study highlight the importance of intensive care nurses recognising the critical role family members play as witnesses whose experiences later allow patients to make sense of their journey post-discharge.     

The experience and challenges of rural persons with cancer and their families

ObjectiveApproximately 30% of the population of Australia live over 180 km from tertiary healthcare facilities. In rural areas there are fewer health resources and greater travelling distances for treatment. Family support for health care or illness prevention can either be strengthened or disrupted in times of need, yet family is a key aspect of the person’s supportive network. This research sought to understand the experiences and challenges for persons with cancer and their families from rural Queensland.DesignA qualitative study used 14 telephone interviews involving eight persons with cancer and six family members to understand their experience when travel for treatment was required.SettingRural Queensland, Australia.ParticipantsPersons with cancer and family who stayed in Cancer Council Queensland Accommodation.ResultsThree themes developed; confronting diagnosis, challenges, and negotiating support.ConclusionsChallenges included travel concerns and lack of services at home; however, family support and appreciating positive aspects were highlighted as part of the experience. This research identified a need for tailored support, which recognises their rurality. Open communication with health professionals helps identify specific needs and service barriers.     

Healthcare Disparities and the COVID-19 Pandemic: Analysis of Primary Language and Translations of Visitor Policies at NCI-Designated Comprehensive Cancer Centers

ContextCoronavirus Disease 2019 (COVID-19) has caused unprecedented disruptions to cancer care, including through strict hospital visitation policies. Since a substantial proportion of the U.S. population report a non-English language as their primary language, it is critical that information is disseminated in multiple languages.ObjectivesTo examine the availability of language translations of visitation restrictions on adult National Cancer Institute-designated comprehensive cancer centers (CCCs) Web sites.MethodsCross-sectional analysis of visitation policies abstracted from public-facing Web sites of CCCs in June 2020. Using U.S. Census data, CCC's city and state proportions of self-identifying Hispanic/Latinx population were categorized into three cohorts: low (<10%), moderate (10%–20%), and high (>20%).ResultsAs of June 2020, all 50 CCCs published a COVID-19 visitation policy on their Web site. Of these, 33 (66%) posted policies only in English, whereas 17 (34%) included one or more non-English translations. A minority of CCCs published Spanish language resources, which did not differ based on state or city demographics: for example, only 42% (8 of 19), 10% (1 of 10), and 38% (8 of 21) of CCCs published Spanish language resources in cities with low, moderate, and high Hispanic/Latinx populations, respectively.Conclusion`Most CCC's did not publish non-English language translations of their visitor policies. Even in cities and states with larger Hispanic/Latinx populations, most CCCs did not publish resources in Spanish. This study highlights a key opportunity to mitigate communication barriers and deliver culturally competent, patient-centered care.     

Implementing intimate partner violence (IPV) screening within emergency departments – Barriers,challenges and enablers experienced by intimate partner violence practice change champions

AimTo identify the barriers, challenges, and enablers that clinical champions experience whilst implementing Intimate Partner Violence (IPV) screening within Emergency Departments (EDs).BackgroundChampions support the introduction of IPV screening within EDs. This paper shares new knowledge about IPV practice change champions: barriers, challenges and enablers they experienced in their efforts.DesignBetween 2017-2019, semi structured qualitative interviews were conducted with 23 individuals who identified as champions, working to introduce routine IPV in two rural tertiary hospital Emergency Departments. An interpretive framework and process of constant comparison was used to thematically analyse data from transcribed interviews.ResultsChampions identified barriers, challenges, and enablers that they experienced. Enablers included: support for the work of champions; champion leadership and collegiality; and training for the champion role. Challenges and Barriers included: resistance to a change in the focus of practice; and workflow and workload.Conclusions and implicationsNurse champions can effectively support IPV practice change but face certain barriers, challenges and enablers. Nurse managers can use this information to support champions to undertake their role effectively in order to better meet the needs of individuals experiencing IPV.     

“Mobile technology to improve heart failure outcomes: A proof of concept paper”

BackgroundHeart failure (HF) causes significant symptom burden and human suffering with considerable economic burden due to hospital readmissions. Targeted interventions to encourage and support self-management behavior is warranted.AimTo test the proof of concept of a mobile application (HeartMapp) in improving self-care management of patients with heart failure.MethodAn exploratory inquiry used a field study strategy with purposeful sampling and constant comparative analysis to test the proof of concept of HeartMapp using The Business Model Canvas framework.ResultsA total of 125 individuals, who were identified as potential candidates to use the HeartMapp completed the interview over a seven-week period in 2016. Constant comparative analysis indicated themes that Skilled Nursing Facilities had increased readmissions. Participants from Skilled Nursing Facilities reported concern on lack of staffing, star rating, and malpractice claims. Two types of patients were identified as early adapters of technology and those in denial. Health care facilities reported challenges on transitional care, nurses struggle with engagement of patients on self-care management. To avoid readmission penalty, hospitals task home care agencies to keep the patients home for 30-days. While home care agencies rely on remote telemonitoring reported that current telemonitoring devices are costly to maintain, thus exploring novel technology.ConclusionThe Business Model Canvas provided directions for future testing of HeartMapp for its usability as an adjunct device in home health setting to improve self-management and enhance communication with providers, and ultimately reduce readmissions.     

Us and them: Experiences of agency nurses in intensive care units

ObjectiveThis qualitative case study describes the work experiences of agency nurses from their perspective. It explores their interactions with intensive care unit managers to whom they report in their designated intensive care units and their relationships with fellow permanent nurses.MethodsA qualitative study was undertaken in three intensive care units at a public hospital in South Africa. Face-to-face interviews were used to collect data from eleven agency nurses. Thematic analysis of the data was undertaken.FindingsThe challenges of agency nursing work were haphazard clinical allocation, a lack of self-efficacy and competence, and feelings of exclusion. Positive aspects of the agency nurse experience included feedback and support from permanent nurses and intensive care unit managers and occurrences of belonging and acceptance.ConclusionThe findings of this study point to the importance of agency nurse relationships with managers and fellow permanent nurses. To ensure patient care is not compromised, managers and nurse managers have a responsibility to ensure a welcoming, inclusive and nurturing environment for all staff tasked with intensive care unit responsibilities.