Room for family-centered care – a qualitative evaluation of a neonatal intensive care unit remodeling project

The physical layout of a Neonatal Intensive Care Unit (NICU) seems to play an important, yet disregarded role in establishing family-centered care (FCC). Based on two focus group interviews this article qualitatively evaluates how a physical layout intervention changed matters for parents and health personnel. Collectively, the participants experienced three interior design layouts: open space design, modified rooms and smaller rooms. Inspired by grounded theory, the article explains how establishing smaller rooms equipped with a parent bed placed next to the sick infant provided “room for family-centered care” in a double sense: it reduced the parents’ burden by providing space for them to come to terms with the situation and to start the bonding process; it allowed professionals to commit to meeting increased demands. The study concludes that smaller rooms enhance FCC in a NICU when personnel are prepared to accept the challenge.     

Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit

OBJECTIVE: To compare changes in the health-related quality of life (HRQOL) of critical care patients by diagnostic category. DESIGN: Prospective, cohort study. HRQOL assessed 3 months before admission and 1 year after discharge from the intensive care unit (ICU). Patients were classified as: trauma injury (TI), scheduled surgery (SS), unscheduled surgery (US), and other medical conditions (MC). SETTING: Department of Intensive Medicine, University Hospital of Bellvitge, Barcelona, Spain. PATIENTS: Three hundred and thirty-four patients admitted to ICU from October 1994 to June 1995 (62 TI patients, 181 SS patients, 19 US patients, and 72 MC patients). INTERVENTIONS: Surgical and medical procedures. MEASUREMENTS AND RESULTS: Changes in HRQOL varied considerably between diagnostic categories, with TI patients having significantly worse HRQOL one year after discharge from the ICU compared to 3 months prior to admission [change in median EQ Visual Analogue Scale (EQ-VAS) score from 100 to 65, P<0.001], and SS patients reporting improved HRQOL (change in median EQ-VAS scores from 60 to 75, P<0.001). Slight deterioration was observed in the other two diagnostic categories. Twelve months after discharge, the EQ dimension in which the largest proportion of patients in all groups reported problems was usual activities (47% of SS and US patients; 69% of TI patients). Using proxy scores at baseline or follow-up had little effect on results. CONCLUSIONS: The degree and direction of change in ICU patients' HRQOL 1 year after discharge depends considerably on diagnostic category. Proxy responses can be reliably used with the EQ-5D when measuring change in HRQOL.     

Quality of life on admission to the intensive care: can we query the relatives?

OBJECTIVE: To study whether the Short Form-36 questionnaire can be used to assess the patient's quality of life on admission to the ICU by use of proxies in both scheduled and emergency admissions. DESIGN AND SETTING: Prospective study involving direct interviews of patients and relatives before or during ICU stay in a 10-bed mixed intensive care unit in a 654-bed university affiliated hospital. PATIENTS AND PARTICIPANTS: Patients before major elective surgery ( n=55) or following emergency admissions ( n=57). MEASUREMENTS AND RESULTS: Patients and proxies completed a health questionnaire in the first 72 h following emergency admission or the day before a scheduled admission to the ICU. Internal consistency was evaluated by measurement of Cronbach's alpha. All dimensions of the SF-36 had adequate internal consistency. On all eight dimensions a significant correlation was found between the patient and their proxy. In general, proxies underestimated the patient's quality of life although differences were small (less than 5%). On most items a good to very good agreement was found (alpha>0.6). Quality of life assessment was not affected by the admission status of the patient (acute or elective admission and surgical or medical diagnosis). CONCLUSIONS: The SF-36 questionnaire completed by a proxy can reliable assesses the quality of life of the critically ill patient on admission to the ICU. Proxies underestimated the patient's quality of life, although the differences were small.     

Discharge from hospital with newly administered antipsychotics after intensive care unit delirium – Incidence and contributing factors

PurposeDelirium in the intensive care unit (ICU) is often treated with haloperidol or atypical antipsychotics. Antipsychotic treatment can lead to severe adverse effects and excess mortality. After initiation in the ICU, patients are at risk of having their antipsychotics continued unnecessarily at ICU and hospital discharge. This study aims to determine the incidence of, and risk factors for antipsychotic continuation at hospital discharge after ICU delirium.MethodsThis retrospective observational study was performed in a tertiary care center. Adult patients who received antipsychotics for ICU delirium during 2016 were included. Data was extracted from patient records. After univariate testing, a multivariate binary logistic regression model was used to identify independent risk factors for antipsychotic continuation.ResultsA total of 196 patients were included, of which 104 (53.1%) and 41 (20.9%) had their antipsychotics continued at ICU and hospital discharge respectively. Medical ICU admission (odds ratio [95% confidence interval] 2.97 [1.37–6.41]) and quetiapine treatment (5.81 [1.63–20.83]) were independently associated with antipsychotic continuation at hospital discharge.ConclusionsApproximately one in five patients were discharged from the hospital with continued antipsychotics. Hospital policies should implement strategies for systematic antipsychotic tapering and better follow-up of antipsychotics at transitions of care.     

Quality of life—a measure of the quality of nursing care?

Quality of life is a very complex phenomenon in the life of cancer patients. Individual perceptions might change with the state of disease and with necessary interventions. Some definitions seem to be more useful in cancer care than others. There has been considerable controversy in the quantity versus quality debate. Some confusion in the measurement of quality of life concerns objectivity and subjectivity, referring either to the content of information or to persons other than the patient eliciting it. The relation between quality of life and quality of care has to be further explored: some dimensions of care might be of little or of potential relevance to the patient's quality of life. The dimensions of proven relevance concern psychological well-being through, for example, promotion of self-care or an enhanced perception of self-worth. These findings emphasise the importance of the concept of care, which is the essence of nursing. Contemporary professional and political difficulties require critical analysis.     

Carer experiences of life after stroke – a qualitative analysis

Aims and objectives.?Carers' experiences of caring for a stroke survivor were explored, including reactions and changes in their lives.

Method.?A phenomenological approach was taken to the collection and analysis of data. Semi-structured interviews lasting an average of 43?min were carried out with nine informal carers in their own homes. All were married to someone who had survived a stroke.

Results.?An overarching theme emerged, entitled: ‘lives turned upside-down’. It took time for participants to understand the long-term impacts of stroke. Carers experienced increased caring and domestic workloads alongside reduced participation and altered expectations of life. They found emotional and cognitive changes in their partners particularly distressing, and would have valued more information and help with adjusting to the increased emotional, physical and cognitive workload of caring.

Conclusions.?It is important to support carers of people who have survived a stroke in adjusting to their changed lifestyles. This may affect their quality of life as well as sustainability of caring, and requires further research.     

End of life in intensive care: Is transfer home an alternative?

The past decade has witnessed an increased focus on improving the quality of end of life care internationally. This has resulted in the development of specific health policy work streams to support patient choice and improve standards of care and patient experience. One concept well explored in areas outside of critical care is that of home care at the end of life. This paper seeks to challenge assumptions and practices about the options for transferring the critically ill patient home at end of life. As a piece of collaborative writing from a bereaved family member and critical care nursing team, this paper explores care given to one gentleman at the end of his life. In this, his journey is detailed, the decisions made are outlined and the experience for him and his family are examined with a retrospective narrative account from his wife that is woven throughout the paper. In this paper, we are not asserting that transfer home at end of life is desirable or feasible for all critically ill patients. We are challenging practitioners to consider when and how the initiative of transferring critically ill patients home at end of life, may occur.     

Quality of life after acute respiratory distress syndrome: a meta-analysis

Objective To summarize long-term quality of life (QOL) and the degree of variation in QOL estimates across studies of acute respiratory distress (ARDS) survivors. Design A systematic review of studies evaluating QOL in ARDS survivors was conducted. Medline, EMBASE, CINAHL, pre-CINAHL, and the Cochrane Library were searched, and reference lists from relevant articles were evaluated. Two authors independently selected studies reporting QOL in adult survivors of ARDS or acute lung injury at least 30 days after intensive care unit discharge and extracted data on study design, patient characteristics, methods, and results.Measurements and results Thirteen independent observational studies (557 patients) met inclusion criteria. Eight of these studies used eight different QOL instruments, allowing only qualitative synthesis of results. The five remaining studies (330 patients) measured QOL using the Medical Outcomes Study 36-Item Short Form survey (SF-36). Mean QOL scores were similar across these studies, falling within a range of 20 points for all domains. Pooled domain-specific QOL scores in ARDS survivors 6 months or later after discharge ranged from 45 (role physical) to 66 (social functioning), or 15–26 points lower than population norms, in all domains except mental health (11 points) and role physical (39 points). Corresponding confidence intervals were no wider than ± 9 points. Six studies all found stable or improved QOL over time, but only one found significant improvement beyond 6 months after discharge.Conclusions ARDS survivors in different clinical settings experience similar decrements in QOL. The precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.This research is supported by National Institutes of Health (ALI SCCOR Grant # P050 HL 73994). D.W.D. is supported by a Medical Scientist Training Program Grant from the National Institutes of Health (Award # 5 T32 GMO7309). D.M.N. is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research and a Detweiler Fellowship from the Royal College of Physicians and Surgeons of Canada.     

Quality of life assessed with Short Form 36 – a comparison between two populations with long-term musculoskeletal pain disorders

Purpose.?To assess quality of life (QoL) in two groups of patients with long-term musculoskeletal pain with and without psychiatric co-morbidity and to compare them with a reference group of normative controls. The patients in both study groups were sick-listed full or part time for 3 months or more.

Method.?The patients were recruited from a company health service and consulting psychiatry. A generic QoL questionnaire, the SF-36, was used to assess QoL. Each group was compared with age- and gender-matched normative controls.

Results.?Both groups reported a pronounced impairment of QoL (p?<?0.001) compared with their age- and gender-matched populations. The greatest impairment was seen among the patients referred for psychiatric assessment (n?=?30). The patients in the company health service (n?=?42) reported significantly higher QoL with regard to the dimensions mental health (p?<?0.028), social functioning (p?<?0.034) and role emotional (p?<?0.040) compared with the patients referred for psychiatric assessment.

Conclusion.?Patients with long-term pain in the company health care and patients with psychiatric co-morbidity, sick-listed full or part-time reported severely impaired QoL with regard both to physical, social and mental dimensions. Psychiatric co-morbidity reported even more pronounced impairment of emotional, social and mental dimensions of QoL which might indicate dysfunctional coping strategies.     

Italian adaptation of the functional outcome questionnaire – aphasia: initial psychometric evaluation

Abstract

Purpose: To evaluate the psychometric properties of the Italian version of Functional Outcome Questionnaire – Aphasia.

Methods: Two hundred and five persons with stroke-related aphasia and right hemiparesis who received ongoing assistance from a family caregiver were assessed using the Functional Outcome Questionnaire – Aphasia, Aachener Aphasie Test, Token Test, Raven’s Coloured Progressive Matrices, Functional Independence Measure (FIM), Functional Assessment Measure (FAM), and Quality of Life Questionnaire for Aphasics (QLQA). The Functional Outcome Questionnaire – Aphasia was translated into the Italian language using a translation and back-translation method. Reliability and construct validity of the Functional Outcome Questionnaire – Aphasia were evaluated.

Results: The Italian version of the Functional Outcome Questionnaire – Aphasia showed good internal consistency and test–retest reliability for the overall scale (α?=?0.98; ICC?=?0.95) and subscales (α?=?0.89 for the communicating basic needs (CBN), α?=?0.92 for the making routine requests (MRR), α?=?0.96 for the communicating new information (CNI), α?=?0.93 for the attention/other communication skills (AO); ICC?=?0.95 for CBN, ICC?=?0.96 for MRR, ICC?=?0.97 for CNI and ICC?=?0.92 for AO). Significant correlations were found between the Functional Outcome Questionnaire – Aphasia and Token Test, QLQA, Aachener Aphasie Test scores, and FAM linguistic scores, indicating good convergent validity. Low correlations were found between Functional Outcome Questionnaire – Aphasia and Raven’s Coloured Progressive Matrices and FIM motor scores, showing good discriminant validity.

Conclusions: The overall findings of this study supported the reliability and construct validity of the Italian version of the Functional Outcome Questionnaire – Aphasia. This measure holds considerable promise in assessing the functional outcomes of aphasia rehabilitation in Italian-speaking persons with aphasia.

• Implications for Rehabilitation

• Functional Outcome Questionnaire – Aphasia is a reliable and valid questionnaire in assessing functional communication of Italian-speaking people with aphasia.

• This measure provides critical information about people with aphasia’s functional and pragmatic communication in home and community settings, contributing significantly to overall quality of life.

• Since the use of measures of functional communication is recommended in the clinical evaluation of language disease, the Italian version of Functional Outcome Questionnaire – Aphasia may be effective in tailoring rehabilitation treatment to the presenting communication problems of people with aphasia and their caregivers.

     

Use of target temperature management after cardiac arrest in Germany – A nationwide survey including 951 intensive care units

Introduction

Target temperature management (TTM) after cardiac arrest is recommended by international guidelines, which have been last updated in 2010. Here we investigate the status of implementation in a nationwide survey in Germany which took place in 2012.

Methods

We conducted a nationwide telephone survey including a total of 951 German intensive care units (ICUs). ICUs were identified by using the online registry for hospitals in Germany. A questionnaire was used for the interview about basic data of the intensive care unit and about details concerning use and implementation of TTM after cardiac arrest.

Results

The overall response rate was 91% (865/951). 86% (742/865) of ICUs used TTM after cardiac arrest and implementation peaked in 2010. 95% (702/736) of the ICUs using TTM perform treatment independently of the initial rhythm and 48% (355/738) apply TTM with the use of a feedback device for cooling and controlled re-warming. However, 22% (166/742) still use conventional methods like ice and cold infusion and only 61% (453/742) of the participants provided a written standard operating procedure (SOP).

Conclusion

With a delay of several years, TTM after cardiac arrest is now implemented in the majority of German ICUs. The moderate proportion of ICUs using SOPs for TTM and feedback-controlled cooling devices indicates the need of further improvement in post cardiac arrest care.     

Clinical review: New technologies – venturing out of the intensive care unit

The delivery of critical care is no longer limited to the intensive care unit. The information gained by utilization of new technologies has proven beneficial in some populations. Research into earlier and more widespread use of these modalities may prove to be of even greater benefit to critically ill patients.