Children visiting family and friends on adult intensive care units: the nurses' perspective

Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.     

Experiences of intensive care unit diaries: 'touching a tender wound'

Aim:  The aim of this study was to describe peoples' experiences of a personal diary written when they were critically ill and receiving care in an intensive care unit (ICU).
Background:  In some ICUs, diaries are written by the ICU staff and close relatives of those who are critically ill and mechanically ventilated, but there is a lack of studies that focus on the experiences of the formerly critically ill of personal diaries written when in an ICU.
Methods:  Qualitative personal interviews were conducted with nine people who were formerly critically ill. The interview texts were analysed using qualitative content analysis.
Findings:  From the analysis of the data, one theme emerged – touching a tender wound, with four categories: being afraid and being deeply touched, appreciating close relatives' notes, a feeling of unreality and gaining coherence. The participants were deeply touched when they read the diary for the first time. Parts of it were experienced as unreal, as if they were reading about someone else. The diary provided necessary knowledge about what had happened during the time when the participants were critically ill and from which they had only fragmented or no memories at all. Even though it aroused strong feelings, reading the diary was experienced as an important support for a long time after their stay in the ICU. Experiencing that one was not fully aware of what had happened and then reading about oneself being critically ill and about one's close relatives' experiences was interpreted as touching a tender wound.
Conclusions and relevance to clinical practice:  It is suggested that a diary may be a tool that can help formerly critically ill people to gain a sense of coherence concerning their critical illness experience, but reading it can be painful and demanding.     

A hermeneutic study of the concept of 'focusing' in critical care nursing practice

A phenomenological hermeneutic study of the lifeworld of critical care nursing was undertaken, from which emerged the concept of 'focusing'. Focusing is defined as empathizing concern for the critically ill person and his/her family amid the high technology of the intensive care unit. When nurses focus on the patient and the patient's family they are able to empathize with die personal dimensions of caring. The study used a phenomenological hermeneutic approach to describe die nature of the lived experience of clinical nursing practice in a high technology environment.     

Re-visiting the ICU: Experiences of follow-up visits to an ICU after discharge: A qualitative study

The aim of this study is to describe how people who have been critically ill, and their close relatives experience a post-discharge, follow-up visit to the intensive care unit (ICU) that provided the care. There is a lack of studies from such a standpoint. The study design is qualitative. A total of 18 adults participated; nine had been critically ill and nine were close relatives, all made a post-discharge follow-up visit to an ICU in the northern part of Sweden. The study data was collected through personal interviews, conducted after the follow-up visit, using a narrative approach. The data were then subjected to qualitative thematic content analysis which resulted in four themes: receiving strength from returning together; making sense of the critical-illness experience; feeling grateful to have survived and the possibility of improving the care. People who had been critically ill and close relatives felt that returning together was valuable. Meeting the staff, with whom participants felt they had developed a relationship, made it possible for them to express their gratitude for the treatment and nursing care received, and to suggest improvements. The interviews revealed that the follow-up visit was seen as an important way of learning what had happened and why during the period of critical illness.     

Critical care nurses' experiences of grief in an adult intensive care unit

Title.  Critical care nurses' experiences of grief in an adult intensive care unit.
Aim.  This paper is a report a study of critical care nurses' experiences of grief and their coping mechanisms when a patient dies.
Background.  The goal of patients entering critical care is survival and recovery. However, despite application of advanced technologies and intensive nursing care, many patients do not survive their critical illness. Nurses experience death in their everyday work, exposing them to the emotional and physical repercussions of grief.
Method.  This study adopted a Heideggerian phenomenological approach, interviewing eight critical care nurses. Data collection occurred in 2007/8. Interviews were transcribed verbatim and themes generated through Colaizzi's framework.
Findings.  Participants reported feelings of grief for patients they had cared for. The death of a patient was reported as being less traumatic if the participant had perceived the death to be a 'good death', incorporating expectedness and good nursing care. They described how a patient's death was more significant if it 'struck a chord', or if they had developed 'meaningful engagement' with the patient and relatives. They denied accessing formal support: however, informal conversations with colleagues were described as a means of coping. Participants exhibited signs of normalizing death and described how they disassociated themselves emotionally from dying patients.
Conclusion.  There are many predisposing factors and circumstantial occurrences that shape both the nature of care of the dying and subsequent grief. Repeated exposure to death and grief may lead to occupational stress, and ultimately burn out. Emotional disengagement from caring for the dying may have an impact on the quality of care for both the dying patient and their family.     

Patient safety and job-related stress: a focus group study.

This study focused on work-related stress among nurses working with critically ill patients. The aim of the study was to examine the effects of work-related stress with regard to patient safety. The study uses a qualitative design based on focus group interviews with nurses who work with acute, critically ill patients in hospitals. Two regional hospitals were chosen. Inclusion criteria for the focus group panels included the following: nurses with advanced training in anesthesiology, intensive care, or operating-room nursing. Twenty-three nurses were chosen and they were divided into four groups. This study shows that a demanding work environment together with minimal control and social support from colleagues results in increased stress that can often have an effect on patient safety.     

Nurses' experiences of caring for the relatives of patients in ICU

To date there have been no published qualitative studies looking solely at the experiences of nurses caring for the relatives of patients who are critically ill. This small-scale phenomenological study explores such experiences. Three intensive care units in North West England were included; the nine participants were D grade or above, with a minimum of three months' ICU experience. Each nurse attended a tape-recorded, unstructured interview to discuss caring for relatives. A thematic analysis of the nurses' comments was then performed. Although many of the nurses understood the benefits of performing the care-giver role to families, some nurses felt inadequately prepared. There were also issues about whether they felt supported by colleagues in undertaking this role.     

Dying and bereavement: The role of the critical care nurse

The critical care units of today are environments totally dedicated to implementing life saving and life supporting measures. The development of the critical care unit is such that now many critical care units offer specific specialised disease/surgical management e.g. the cardiothoracic unit, transplant centres. As the ability of the critical care units to offer extensive life supportive measures continually improves, the fact is that there is still an increased potential for death to occur in the critical care unit, more than in other acute areas.While the prime function of the critical care staff will always be to support and sustain the life of their patients for whom they care, they also have a responsibility to offer a caring and compassionate level of care to the dying critically ill patient and to ensure that they support the dying patients' relatives in every way that they can.The prospect of death (for the patient), and the actual loss of the patient (for the relatives/medical and nursing staff) can present a number of difficulties for all those involved. These difficulties, which will be identified in the course of the article, may if unresolved predispose to a poor and traumatic bereavement process for the relatives, while the critical care staff may experience possible feelings of frustration, helplessness and low morale. (Caughill, 1976). It is therefore the aim of this article to examine the role of the critical care nurse in caring for the dying patient in the intensive care areas. It will aim to offer some insight into the nature of grief, the process that may follow, and to relate this to the possible difficulties that the bereaved relatives may experience following the loss of their family member in the critical care setting. It will also identify those measures that can be implemented to promote a caring approach to meeting the needs of the dying critically ill patient, the bereaved relatives, and in which the health care professionals can take support and comfort during this difficult time.     

Cardiovascular nurses' experiences of working in the COVID-19 intensive care unit: A qualitative study

BackgroundCardiovascular nurses’ skills and experiences of cardiac critical care, management of cardiovascular emergencies, and mechanical circulatory support have been considered vital in providing nursing care for COVID-19 patients in intensive care units during the COVID-19 pandemic. To our knowledge, there are no studies have focused on the contribution and experiences of cardiovascular nurses in the critical care of COVID-19 patients.ObjectivesTo explore the experiences of cardiovascular nurses working in a COVID-19 intensive care unit during the pandemic.MethodsThe study was conducted as a qualitative study with phenomenological approach in June-December 2020. Study data were gathered from ten cardiovascular nurses through semi-structured interviews.ResultsSix themes emerged from the interview data: the duties and responsibilities in a COVID-19 intensive care unit; the differences of COVID-19 intensive care unit practices from cardiovascular practices; the transferrable skills of cardiovascular nurses in a COVID-19 intensive care unit; the difficulties encountered working in a COVID-19 intensive care unit; the difficulty of working with personal protective equipment; and the psychosocial effects of working in a COVID-19 intensive care unit.ConclusionCardiovascular nurses made an important contribution to the management of nursing services with their experiences and skills in the COVID-19 pandemic.     

Confidence as a factor in chronic illness care

Confidence is generally regarded as a positive quality which enhances personal coping and success. For those who are chronically ill and face a life of uncertainty, confidence becomes especially important. In a recent qualitative study examining chronically ill patients' perceptions of nursing care, confidence was found to be the grand essence which tied together all the informants' experiences with good nursing care. The informants entered the hospital with the expectation that the nurses would and could look after them. Observing and receiving good nursing care reinforced this confidence. In addition to this, the informants referred to confidence that was developed by the interest and value the nurses placed on the patient as an individual. Showing an interest in the patient as an individual gave the patient confidence in self-worth and in personal coping ability. These two sources of confidence combined to give the informants confidence in their futures. In the nursing literature the exploration of the concept of confidence is minimal. This paper discusses confidence as a factor in the care of the chronically ill using data from the study for illustration.     

Professional nursing support for culturally diverse family members of critically ill adults

Family members' perceptions of professional support expected of critical care nurses were examined for differences related to cultural affiliation using the "Professional Support Questionnaire for Critical Care Nurses Working with Family Members" (PSQ). The PSQ was administered face-to-face to family members waiting to visit a critically ill relative admitted to the intensive care unit. ANOVA and post hoc tests were computed to compare 90 family members' expectations for professional nursing support during a relative's critical illness across three cultural groups-African American, Hispanic, and White. There were significant differences in family members' responses on certain PSQ items across cultural groups. Despite these differences, family members' expectations of professional support from critical care nurses were generally universal-suggesting equitable care, dignity, and respect should be universal values. There is a need for critical care nurses to develop interventions that respect some cultural uniqueness as well as address the universal needs of family members coping with the ICU admission of a critically ill family member.