Critical care family needs: nurse-family member confederate pairs

In this study we explored the relationship between critical care family members' perceived needs and the assessment of these needs by a confederate sample of intensive care unit (ICU) nurses. Family needs were measured by using Molter's revised Critical Care Family Needs Inventory. Data consisted of 92 confederate pairs of Critical Care Family Needs Inventory responses obtained from 92 family members of adult patients hospitalized in a variety of ICUs and 49 ICU nurses providing direct care for these patients. Paired t tests (two tailed) were calculated to detect significant differences between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of the needs studied. Family members' perceptions and ICU nurses' assessments of the most and least important critical care family needs were identified. Significant (p less than 0.001 to p less than 0.05) differences were detected between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of 15 (50%) of the critical care family needs studied. Therefore, it appears that these nurses were only moderately accurate in their assessments of critical care family needs. Implications for nursing practice, education, and research were identified and discussed.     

Burnout syndrome in critical care nursing staff

RATIONALE: Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The intensive care unit (ICU) is a highly stressful environment. Little is known about BOS in critical care nursing staff. OBJECTIVES: To identify determinants of BOS in critical care nurses. METHODS: We conducted a questionnaire survey in France. Among 278 ICUs contacted for the study, 165 (59.4%) included 2,525 nursing staff members, of whom 2,392 returned questionnaires with complete Maslach Burnout Inventory data. MEASUREMENTS AND MAIN RESULTS: Of the 2,392 respondents (82% female), 80% were nurses, 15% nursing assistants, and 5% head nurses. Severe BOS-related symptoms were identified in 790 (33%) respondents. By multivariate analysis, four domains were associated with severe BOS: (1) personal characteristics, such as age (odds ratio [OR], 0.97/yr; confidence interval [CI], 0.96-0.99; p=0.0008); (2) organizational factors, such as ability to choose days off (OR, 0.69; CI, 0.52-0.91; p=0.009) or participation in an ICU research group (OR, 0.74; CI, 0.56-0.97; p=0.03); (3) quality of working relations (1-10 scale), such as conflicts with patients (OR, 1.96; CI, 1.16-1.30; p=0.01), relationship with head nurse (OR, 0.92/point; CI, 0.86-0.98; p=0.02) or physicians (OR, 0.81; CI, 0.74-0.87; p=0.0001); and (4) end-of-life related factors, such as caring for a dying patient (OR, 1.39; CI, 1.04-1.85; p=0.02), and number of decisions to forego life-sustaining treatments in the last week (OR, 1.14; CI, 1.01-1.29; p=0.04). CONCLUSION: One-third of ICU nursing staff had severe BOS. Areas for improvement identified in our study include conflict prevention, participation in ICU research groups, and better management of end-of-life care. Interventional studies are needed to investigate these potentially preventive strategies.     

上海市参与新型冠状病毒肺炎危重症护理护士胜任力和应对能力现状分析

目的 ：调查上海市参与新型冠状病毒（新冠）肺炎危重症护理护士的重症监护病房（intensive care unit,ICU）胜任力和传染病突发事件应对能力现状,并分析其影响因素。方法 ：采用便利抽样法抽取上海市6所三级甲等医院参与过新冠肺炎ICU工作的护士234名为研究对象。按原科室属性分为ICU组和非ICU组,采用ICU护士胜任力调查问卷和医护人员传染病突发事件应对能力调查问卷分别进行调查。结果：回收有效问卷234份,其中ICU组44份,非ICU组190份。2组ICU护士胜任力均处于良好水平,ICU组[（82.23±10.02）分]高于非ICU组[（71.14±11.36）分]（P<0.05）,ICU组的良好及以上水平达到70.5%,非ICU组仅56.9%,而ICU组处于合格及以下水平的护士占29.5%。传染病突发事件应对能力ICU组为（3.62±0.70）分,非ICU组为（3.50±0.65）分,ICU组在准备、救援和整体应对能力均显著高于非ICU组（P<0.05）。多元线性回归显示,工作年限、是否具有突发事件应急救援经历和传染病突发事件应对能力等级是参与新冠肺炎危重症...     

Comparison of perceived needs of family members between registered nurses and family members of critically ill patients in intensive care and neonatal intensive care units

Using the Norris and Grove (1986) questionnaire of perceived needs of families of critically ill patients, 11 registered nurses working in the neonatal intensive care unit and 19 registered nurses working in the intensive care unit of two mid-northern community hospitals provided their perceptions of family needs. Their responses were compared with responses of family members of patients in the intensive care unit (n = 25) and the (n = 24). Results suggest that regardless of unit, registered nurses' perceptions of family needs are congruent. Family members collectively and by unit ranked their needs consistently higher and in some areas differently than did the registered nurses.     

Family satisfaction in the ICU: differences between families of survivors and nonsurvivors

BACKGROUND: We previously noted that the families of patients dying in the ICU reported higher satisfaction with their ICU experience than the families of survivors. However, the reasons for this finding were unclear. In the current study, we sought to confirm these findings and identify specific aspects of care that were rated more highly by the family members of patients dying in the ICU compared to family members of ICU survivors. METHODS: A total of 539 family members with a patient in the ICU were surveyed. Family satisfaction was measured using the 24-item family satisfaction in the ICU questionnaire. Ordinal logistic regression identified which components of family satisfaction were associated with the patient's outcome (ie, whether the patient lived or died). RESULTS: A total of 51% of respondents had a loved one die in the ICU. Overall, the families of patients dying in the ICU were more satisfied with their ICU experience than were families of ICU survivors, and the largest differences were noted for care aspects directly affecting family members. Significant differences were found for inclusion in decision making, communication, emotional support, respect and compassion shown to family, and consideration of family needs (p<0.01). CONCLUSIONS: The families of patients dying in the ICU were more satisfied with their ICU experience than were the families of ICU survivors. The reasons for this difference were higher ratings on family-centered aspects of care. These findings suggest that efforts to improve the support of ICU family members should focus not only on the families of dying patients but also on the families of patients who survive their ICU stay.     

A survey on the view of end-of-life care in the elderly -a comparison among elderly patients, family members. physicians, nurses, and other caregivers

AIM: The purpose of this study was to investigate the role of geriatric physicians in end-of-life care through surveying elderly patients, their families, and health-care providers including physicians, nurses, and other caregivers, in order to determine what comprises good end-of-life care. METHODS: The survey respondents comprised 148 elderly patients, 76 members of their families, 105 physicians, 784 nurses, and 193 other caregivers. The survey asked respondents to rate the importance of (a) indicators of end-of-life in the elderly and (b) 17 aspects of quality of end-of-life care. RESULTS: With respect to indicators of end-of-life in the elderly, a patient being consistently critically ill was rated highly by all health-care providers (>70% responded that this indicated end-of-life). Being unable to perform the activities of daily life was considered an indicator of end-of-life by 36% of patients and 45% of their family members, but only by 23% of physicians, 8% of nurses, and 24% of other caregivers. For quality of end-of-life care, four items were rated as being important by all groups (>70% in each group): palliation of pain, freedom from anxiety regarding death, ability to spend time with close friends or family, and being respected. However, respecting the patient's principles and lifestyle was thought to be less important by patients (16.1%) and family members (28.2%) than it was by physicians (63.8%). Death at home was also thought to be less important by patients (21.0%) and family members (7.1%) than by physicians (37.5%). CONCLUSION: Elderly patients and their families have different views from their health-care providers on matters related to good end-of-life care. Geriatric physicians should pay attention to not only the care of patients' physical needs, but also other needs of the patients and their families.     

French validation of the critical care family needs inventory

This study is a contribution to the French validation of Molter and Leske Critical Care Family Needs Inventory (CCFNI). The importance of this validation study is based on the presumption that evaluation of family needs relies on the use of measures that are reliable and valid for a specific population. The preliminary validation of the French text of the CCFNI was carried out by back translation method of the French form into English by three translators. Then the final French version was selected. The study was conducted in the surgical intensive care unit of the University Hospital in Sherbrooke, Canada. The sample consisted of 207 voluntary subjects selected from adult members of the immediate family visiting a patient in the intensive care unit. The data collection was spread over a 10-week period. The French version of the CCFNI was given to subjects for self-reporting at the end of a 15-minute face-to-face interview. The reliability of the French version yielded 0.91 as Cronbach alpha coefficient. The Spearman-Brown split-half coefficient was 0.89, and the Guttman split-half coefficient was 0.88. Principal-component analysis and factorial matrices were used to examine the clustering structure of the French version of this instrument.     

Intermediate geriatric care in Geneva: A 10-year experience

The ageing of the population generates an increased demand for acute healthcare services in persons aged over 65, who can represent up to half of the patients treated in intensive care units (ICU). However, the number of available ICU beds is limited. Intermediate care units (IntCU), requires less human and technical resources, and has been proposed as an alternative to intensive care in the geriatric population. This article reports a 10-year, single centre experience from Geneva of continuous care and its impact on mortality in a geriatric population. Between 1998–1999 and 2000–2001, after the creation of the IntCU, we observed a significant reduction in in-hospital mortality. Thanks to increased medical and nursing care, IntCUs provide greater security for patients and their family, thereby improving their satisfaction with care.     

Quality of dying and death in two medical ICUs: perceptions of family and clinicians

OBJECTIVE: We compared perceptions of the quality of dying and death in the ICU across nurses, resident physicians, attending physicians, and family members. The aim was to obtain a surrogate assessment of the quality of the dying process and examine differences in the perceptions of different types of raters. DESIGN: Cross-sectional survey of family members and ICU clinicians conducted following the death of enrolled patients. SETTING: Two medical ICUs at academic tertiary care medical centers. PATIENTS: Patients dying in the ICU (n = 68). MEASUREMENTS AND RESULTS: The previously validated Quality of Dying and Death (QODD) instrument was modified for use in the ICU. Within 48 h of the time of death, the nurse, resident, and attending physician caring for the patient were asked to complete the QODD. One month following the death, a designated family member was contacted and the QODD was administered on the telephone. Family members and attending physicians gave the most favorable ratings of death, while nurses and residents provided less favorable ratings. Significant differences between these groups were notable (p < 0.01) on items related to patient autonomy: maintaining dignity, being touched by loved ones, and the overall quality of death. CONCLUSIONS: The perception of dying and death in the ICU varies considerably between nurses, attending physicians, resident physicians, and family members. Further studies are needed to explain these differences and determine the utility of the ICU QODD instrument for assessing and improving the quality of end-of-life care in the ICU.     

Family member presence during cardiopulmonary resuscitation: a survey of US and international critical care professionals

OBJECTIVE: Recent international emergency cardiovascular care (ECC) and cardiopulmonary resuscitation (CPR) guidelines have recommended that health-care professionals allow family members to be present during resuscitation attempts. To assess whether critical care professionals support these recommendations, we surveyed health-care professionals for their opinions regarding family-witnessed resuscitation (FWR). METHODS: We surveyed health-care professionals attending the International Meeting of the American College of Chest Physicians in San Francisco, CA, from October 23 to 26, 2000, about their CPR experience, their opinions on FWR, and demographic characteristics. The opinions of physicians, nurses, and other allied health professionals were compared, and differences in opinions based on demographics were examined. RESULTS: Five hundred ninety-two professionals were surveyed. Fewer physicians (20%) than nurses and allied health-care workers combined (39%) would allow family member presence during adult CPR (p = 0.0037 [chi(2) test]). Fourteen percent of physicians and 17% of nurses would allow a family presence during pediatric CPR. There was a significant difference among the opinions of US professionals, based on regional location. Professionals practicing in the northeastern states were less likely than other US professionals to allow FWR during adult or pediatric resuscitations (p = 0.016 and p < 0.001, respectively [chi(2) test]). Midwestern professionals were more likely than others to allow family members to be present during an adult resuscitation, when compared to professional in the rest of the nation (p = 0.002 [chi(2) test]). Health-care professionals disapproving of family member presence during CPR did so because of the fear of psychological trauma to family members, performance anxiety affecting the CPR team, medicolegal concerns, and a fear of distraction to the resuscitation team. CONCLUSIONS: Our evaluation indicated that the majority of critical care professionals surveyed do not support the current recommendations provided by the ECC and CPR guidelines of 2000.     

An evaluation of validity, reliability, and readability of the Critical Care Family Needs Inventory

The benefits of caring for the family as well as the patient are well supported in the literature. The Critical Care Family Needs Inventory (CCFNI) has been used by several researchers to identify the needs of family members when a relative is admitted to a critical care setting. However, no research to date has comprehensively evaluated the instrument's content validity, test--retest reliability, or readability. The CCFNI, after review by a panel of 16 experts, was given on two separate occasions to a random sample of 51 family members of adult patients in both medical and surgical intensive care units. Overall content validity was established, but the panel found numerous redundancies among the need statements, suggesting that several items might need to be eliminated or combined. Among family members, a percentage of exact agreement of 70% or greater was calculated for 86.7% of the need statements demonstrating acceptable test--retest reliability. The Gunning Fog Index, used to evaluate readability, was calculated at 9.0, indicating that the CCFNI could be read and understood by those with a ninth grade reading level. Suggestions are made for additional studies to establish the reliability and validity of this widely used instrument.     

Behavioral disturbance in severe Alzheimer's disease: a comparison of family member and nursing staff reporting.

OBJECTIVE: The purpose of this study is to describe the behavioral disturbances in a group of patients with severe Alzheimer's disease and to compare family members' and nursing staff members' perceptions regarding these behaviors. DESIGN: Cross-sectional survey. SUBJECTS: The 33 subjects resided in nine different long-term care facilities in the Rochester, NY area and were selected from a group of patients enrolled in a longitudinal research study of Alzheimer's disease, based on having severe disease. OUTCOME MEASURES: Caregivers were surveyed with a self-administered questionnaire. The primary outcome measures were the prevalences of 13 behaviors and the magnitude of caregiver concern reported by each group of caregivers. RESULTS: Compared with family members, nurses reported more concern with vegetative behaviors (incontinence, dietary change, and sleep disturbance; P = 0.055). There was statistical evidence that the number of behaviors reported by the nurses decreased with increasing disease severity (P = 0.002). Although not statistically significant, the magnitude of concern reported by the nurses also decreased with increasing disease severity (P = 0.063). Family members and nurses frequently disagreed about the presence of many behaviors exhibited by individual patients, and the responses of caregivers within the same group were highly variable. CONCLUSION: Institutionalized patients with severe Alzheimer's disease continue to exhibit troublesome behaviors although overall behavioral disturbance and concern appear to decrease with increasing disease severity. The assessment of these behaviors and their impact on caregivers can be very subjective, depending in part on the role of the caregiver.     

Improvement of nursing quality and outcome in intensive care patients with acute kidney failure

Collaboration between the Intensive Care Unit (ICU) and nephrology nurses is needed to ensure adequate care of critically ill patients with acute renal failure (ARF). To improve this collaboration a questionnaire was circulated to the 122 ICU nurses in the hospital to appraise their knowledge on ARF. A Refresher Course to update on ARF was then organised. Colleagues' interest in the initiative was elevated: 66% of questionnaires were completed which included 88% of nurses attending the course. The experience showed, through measurable results, that team work is essential to collaborative nursing plans. The initiative allowed improvement in the quality of nurses' communication and was accompanied with a significant reduction in short-term mortality rate of dialyzed ARF patients (45 versus 50%; p = 0.045, chi-square test). Despite the limitations of this short period of observation one year) the results are judged as useful. Collaboration ensures support for colleagues on a daily basis and during critical moments and can encourage appreciation of the nursing profession.     

Erhebung der Patientenzufriedenheit in der Geriatrie

The assessment of patient satisfaction using mailed questionnaires is an established method of quality management in acute care hospitals in our health care system. The needs of aged patients and the inter-professional approach of geriatric medicine are, however, not taken into account by such surveys. To date, validated German instruments to assess patient opinions in geriatric in-hospital care are rare. We report the results of a multi-center feasibility study of a questionnaire developed especially for such needs. We examined 1918 patients with a median age of 82 years and a mean Mini- Mental Score (MMS) of 25 points in 3 Swiss geriatric hospitals. We examined the results of all completed written questionnaires for their psychometric properties. In parallel, we assessed the satisfaction of the patient's spouses or family members applying the same instrument. The return rate was 32% when the instrument was applied as a questionnaire and 60% when applied as an interview. In questionnaires, the return rate was dependent on cognition with lower return in patients with low MMS scores. The return rate of questionnaires mailed to family members was 35%.The theoretical construct patient satisfaction was reliable and valid. The Cronbach-Alpha values in different item areas ranked between 0.67 (hotel services, room quality) and 0.92 (physicians). We were not able to assess the quality of medical therapies and of pain treatment due to low answer frequencies. Overall, patients were satisfied with all medical services in the participating hospitals. In contrast, satisfaction was low in family members regarding the quality of information flow between family members and physicians or nurses. CONCLUSIONS: An instrument to assess patient opinions can easily be introduced into a geriatric hospital. Such an instrument can provide important information for the improvement of quality in different areas of geriatric care such as medical, nursing care or guest services.