Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria,Australia

IntroductionFamily Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR.MethodsOne rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study.ResultsSeventeen adult presentations (Metro n = 9, Rural n = 8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication.ConclusionDuring 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education.     

Termination of professional responsibility: Exploring the process of discharging patients with heart failure from hospitals

Hekmatpou D, Mohammadi E, Ahmadi F, Arefi SH. International Journal of Nursing Practice 2010; 16 : 389–396
Termination of professional responsibility: Exploring the process of discharging patients with heart failure from hospitals Despite the emphasized importance of the discharge process for patients with heart failure, this process is not taken as seriously as it should be. The objective of this qualitative study is to explore the concept of discharge and its associated factors in 42 experienced patients, family members, nurses and cardiologists at two educational hospitals in Tehran, Iran. The content analysis of the data indicates that the participants consider hospital discharge as the termination of professional responsibility on the part of physicians and nurses as far as health‐care support is involved. Three themes were identified as factors related to the treating team, health‐care system and patients and their families. Adverse outcomes of inappropriate discharge planning which manifested as incompliance with ‘diet and medical regimen’ and lack of lifestyle modification were also noted. It seems proper to try and change the attitude of physicians and nurses towards the concept of discharge, and raise their sensitivity to organizing and executing discharge plans. It is also recommended that postdischarge care should be established.     

The impact of family visitor restrictions on healthcare workers in the ICU during the COVID-19 pandemic

PurposeTo obtain information on how family visitor restriction during the COVID-19 pandemic has impacted the workplace experience of physicians and nurses in the medical intensive care unit, and to assess differences by profession.Materials and methodsWe developed a survey containing closed- and open-ended questions, applying both quantitative and qualitative analyses to our results.ResultsOf the 74 respondents, 29 (38%) were nurses and 45 (62%) were physicians. Nurses reported positive changes to daily workflow and the ability to provide medical care, while physicians reported negative changes in these areas. Both groups reported decreased comprehension and increased distress among families, and decreased ability to provide end-of-life care. For the qualitative analysis, eight themes were identified: the patient’s room as space, creation of a new space through virtual communication, time, increased complexity of care, challenges around the use of technology, adjustments to team roles and responsibilities, desire for families to return, and internal tension.ConclusionIntensive care physicians and nurses reported both positive and negative effects of family visitor restriction during the COVID-19 pandemic, with significant differences based on profession. Both groups expressed concern for an overall negative impact of visitor restriction on healthcare workers, patients, and their families.     

Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study

BackgroundFamily member presence in the intensive care unit is important for patient well-being and recovery. Limitations to visits increase the risk of psychological distress in family members. During the COVID-19 pandemic, in-person visiting restrictions were introduced to prevent the spread of infection.PurposeTo explore the experience of in-person visiting restrictions imposed during the pandemic on family members of patients with COVID-19 admitted to an intensive care unit.MethodQualitative method with thematic analysis. Individual semi-structured telephone interviews were conducted.FindingsWe interviewed 21 family members. The results are presented in one overall theme with two main themes and five sub-themes. The theme ‘Striving for closeness even at a distance describes the experience of being kept at a physical distance when participants needed closeness the most. Even participants who were allowed in-person visits perceived a ‘distance’ due to personal protective equipment or because they could only view the patient from a window. Participants reported that contact with and information about the patient was of utmost importance. Visits were viewed as essential in providing for the patient’s wellbeing. Meaningful contact with the ICU team was vital for getting useful information. Phone calls became a lifeline, with digital aids such as video calls used occasionally to overcome the feeling of distance.ConclusionVisiting restrictions imposed during the COVID-19 pandemic made straightforward and comprehensible communication of information from the ICU team more essential to reduce family members’ perceptions of distance and exclusion from the intensive care unit.     

Percepciones de las enfermeras sobre el apoyo de los compañeros de trabajo en el lugar de trabajo: investigación cualitativa

ObjectiveAlthough the psychological factors of the work environment affect the quality of employees’ performance more than physical factors, they have not been broadly explained yet. This study is conducted to explore nurses’ perceptions of the co-worker support as psychological resource in the workplace.MethodThe present study is a qualitative research. Fourteen staff nurses who were working in hospitals affiliated to the Khoy University of Medical Sciences, Iran were selected based on purposeful sampling and interviewed using un-structured in-depth interviews. All interviews were recorded, transcribed, and analyzed using conventional content analysis approach through constant comparative method.ResultsData analysis revealed four major themes with 11 sub themes. The four major themes include ‘emotional support’, ‘effective working relationship and collaboration’, ‘suitable social relationships’, and ‘guidance and teaching’.ConclusionThe results showed that, nurses had a positive perception of their colleagues’ support in the workplace. Co-worker support is a multidimensional phenomenon and is influenced by various factors. Perceiving support from the colleague and having a sense of support can promote the quality of care and increase dealing with stressful situations in nursing. Therefore, communication and flexibility skills should be taught to both staff and managers in this regard.     

Prevenir y tratar delirium en cuidados intensivos: hermenéutica de las vivencias del equipo de enfermería

ObjectiveTo understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units.MethodologyHermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle.ResultsFour significant themes emerged from the analysis: 1) Delirium prevention, 2) Pharmacological treatment, 3) Non-pharmacological treatment, and 4) Barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team.ConclusionsThe experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.     

The educational experiences and needs of patients with an internal cardiac defibrillator: An interpretive phenomenological study

BackgroundInternal cardiac defibrillators (ICD) are the treatment option for primary and secondary prevention of sudden cardiac arrest and potential death. The majority of research to date has focused on the psychological and physical outcomes affecting patients, such as fear, anxiety, depression, and changes in quality of life post ICD insertion. There is, however, limited research exploring the adequacy of their educational preparation by nurses and other health care professionals.AimThe aim of this study was to understand the educational experiences and needs of adult patients with ICDs within a metropolitan tertiary hospital in Queensland.MethodsAn interpretive phenomenological approach was chosen to explore the everyday educational experiences and needs of patients with an ICD or Subcutaneous Internal Cardiac Defibrillator (S-ICD). Semi-structured interviews were conducted with a purposive sample of ten participants until data saturation was reached. Thematic analysis was used to analyse the data.FindingsFive themes emerged and these were ‘understanding the information needs of patients’; ‘psychological aspects’; ‘fearful of the ICD shock’; ‘physical concerns’; and ‘importance of family inclusion’.DiscussionThe study’s findings revealed that patients with ICD/S-ICDs had unmet educational needs that are important for nurses to understand and address. These specifically related to education and the relevance to each individual’s particular needs. These included addressing their anxiety levels explaining changes to everyday activities and including family in the education sessions. Discharge care via telemonitoring may be useful for follow-up care for this unique and vulnerable patient group.ConclusionInterpretive phenomenology was used to understand the experiences and needs of people living with an ICD/S-ICD. This study has provided knowledge about the patient’s desire for clarity of information relevant to their individual needs. The research found that patients with ICD/S-ICDs did not perceive the education that they received regarding the device to be adequate, nor did it address their specific needs. The research highlighted that nurses caring for patients undergoing ICD/S-ICD insertion need to provide education that is both patient and family specific, and that it continues for at least two months post-hospital discharge.     

Surgical nurses’ responses to worry: A qualitative focus-group study in the Netherlands

BackgroundHospital nurses observe and respond to deterioration using the ‘National Early Warning Score 2’. Surgical nurses are highly engaged in the early recognition of and response to deterioration. Responses to deterioration are based on deviating vital signs, while nurses also act on subjective indicators like worry. Scientific literature and (inter)national guidelines do not mention any information about acting upon worry.ObjectiveTo gain an in-depth understanding of the actions nurses on surgical wards undertake to generate an appropriate response to nurses’ worry when the ‘National Early Warning Score 2’ does not indicate deterioration.MethodA qualitative focus-group study with surgical nurses working at a hospital in the Netherlands. Data was collected by focus-group interviews supported by vignettes and analysed thematically.FindingsFour focus-group interviews with a total of 20 participants were conducted between February and April 2020. Two sequential themes emerged: ‘Searching for explanation and confirmation’ and ‘Responding by actively applying nursing interventions’. Nurses gathered additional information about the patient and searched for a reference point to place this information in perspective. Nurses also approached others for co-assessment and verification. However, nurses faced barriers in calling for medical assistance. They felt physicians did not take them seriously. After gathering additional information, nurses responded by applying nursing interventions to comfort the patient.ConclusionNurses mainly try to formalise an in-depth understanding of their feeling of worry to convince a physician to accurately treat the patient. Spending much time on a search to this understanding leads to delays in escalating care.     

Peripheral intravenous cannulas for blood drawing: Nurses' views through content analysis

BackgroundPeripheral intravenous cannulas are commonly used for blood sampling. Conflicting evidence on the safety and reliability of blood sampling from peripheral intravenous cannulas provides little support to guide practice of clinicians.AimTo elicit views of nurses working in acute care of their opinions on the safety and efficacy of obtaining blood samples from peripheral intravenous cannulas.MethodsA cross-sectional electronic survey was utilised. Participants included nurses working in Australian acute care services nationally. The STROBE checklist was followed. The survey was distributed by two professional nursing bodies to their members between September and December 2017. Content analysis was used to analyse open-ended responses.FindingsOf the 338 participants who completed the survey, 269 provided comments. Themes supporting the use of peripheral intravenous cannulas for blood sampling included ‘efficiency’, ‘patient care’, ‘last resort’, and ‘other’. Reasons for not using a peripheral intravenous cannula for sampling provided themes of ‘PIVC use’, ‘dwell time’, ‘test type required’, ‘patency/insertion site care’, ‘preference’, and ‘other’.DiscussionThe choice regarding method of blood sampling is left to the discretion of individual practitioners. Diverse rationales were provided by respondents to support their practice in sampling blood. This may be influenced by variations in hospital policies and conflicting research evidence to support or refute the practice.ConclusionBlood sampling from peripheral intravenous cannulas or venepuncture is practiced differently between nurses based on multiple rationales. Research is needed to provide evidence for safe practice and support hospital policies.     

Fulfilling the psychological and information need of the family members of critically ill patients using interactive mobile technology: A randomised controlled trial

BackgroundIntensive care nurses may have an important role in empowering families by providing psychological support and fulfilling the family's pivotal need for information.AimTo determine whether ‘education of families by tab’ about the patient’s condition was more associated with improved anxiety, stress, and depression levels than the ‘education of families by routine’.Research designA randomized control trial of 74 main family caregivers (intervention: 39; control: 35).SettingAn adult intensive care unit.Main outcome measuresDepression Anxiety Stress Scale, and Communication and Physical Comfort Scale.ResultsAlthough information need satisfaction was not significantly different between intervention and control groups, the former reported significantly better depression score on Depression Anxiety Stress Scale comparing to the control group (p < 0.01; η² = 0.09) with a medium effect size. Reduction of anxiety in the intervention group were clinically significant.ConclusionThe results suggest that use of ‘education of family by tab’ is promising for intensive care nurses to provide psychological support for family members. More studies are needed to investigate this aspect of family care for better psychological support and information need satisfaction that contributes to the evidence-based practice of intensive care nursing.     

Nurses' perspectives on advance directives before the establishment of the new well-dying law in Korea: A mixed methods study

AimThis study explored the attitudes, experiences, and perceptions of Korean nurses toward advance directives (ADs) before the establishment of new Well-Dying Law.MethodsA sequential explanatory mixed method design was applied. We administered a constructed questionnaire on attitudes toward ADs and end-of-life issues and experience related to end-of-life decision-making. A Korean-translated version of the KAESAD [Knowledge-Attitudinal, Experimental Survey on ADs] was administered by 245 nurses. Semi-structured interviews (N = 16) were audio-recorded, transcribed, and coded in a qualitative content analysis.ResultsThe quantitative results revealed the nurses' perspectives on ADs: that valuing patient's autonomy, authority, or rights is vital to the implementation of ADs and end-of-life decision-making. Also, nurses reported that patients should be knowledgeable and informed about ADs. These responses allowed us to generate an interview, which revealed four themes in adopting the Well-Dying Law, including ADs. Themes with ‘benefits’ and ‘roles of health care providers’ mainly supported the quantitative results. Themes with ‘ethical issues,’ such as disagreement between patients and family members on ADs, and ‘preparation,’ regarding adopting the new law, should be importantly considered when implementing ADs in clinical settings.ConclusionsOur study highlights that nurses need to develop sufficient knowledge on the laws, and communication skills to help patients be knowledgeable and make their own decisions regarding ADs. To successfully adopt the Well-Dying Law, our findings suggest that a nationwide public campaign and a continuing education program for nurses to manage ethical issues regarding ADs are required.