Factors associated with family satisfaction in the adult intensive care unit: A literature review

ObjectiveThe objective of this study was to identify and summarise factors associated with family satisfaction among family members of adult intensive care unit (ICU) patients.Review methods/data sourcesA search was conducted from inception to October 2020 in the following databases: PubMed, Scopus, EMBASE, CINAHL Plus, ProQuest Health Management, PsycINFO, LILACS, and SciELO. Studies reporting the questionnaire's items or dimensions as family satisfaction factors, studies dichotomising family satisfaction outcome, and those involving family members of neonatal, paediatric, palliative, and end-of-life patients were excluded. Quality of the studies was examined through a modified approach to the Consolidated Standards for Reporting Trials (CONSORT). Reported factors were classified as family member, patient, or provider/organisation related.ResultsThe search yielded 26 articles reporting factors associated with family satisfaction in the ICU. Regarding study quality, 19.2% were classified as high-quality studies. Family member–related variables such as educational level, gender, and kinship to the patient showed divergent associations with family satisfaction. Within patient-related variables, the severity of illness was positively associated with family satisfaction. Factors related to healthcare providers and organisations were reported only in 26.9% of the studies.ConclusionsA broad number of factors associated with family satisfaction in the ICU were found in this review. However, few nonmodifiable factors related to the family members and the patient showed a significant and consistent association with family satisfaction. Evidence on factors related to healthcare providers was scarce. Gaps in knowledge regarding family satisfaction in the ICU, including methodological issues that impair the validity of the findings, were identified. Future studies should address these limitations to accurately identify factors that impact family satisfaction in the ICU.     

Family participation during physical activity in the intensive care unit: A longitudinal qualitative study

PurposeFamily-centered care has been implemented in the ICU to meet relatives' needs concerning information, support, participation and shared decision making. This study explores the needs, beliefs, feelings and behaviors of relatives of patients admitted to the ICU regarding participation during physical activity.MethodsLongitudinal qualitative study design following a grounded theory approach. Relatives were interviewed at 4, 8 and 12 days after the patient's ICU-admission. Data were analyzed using constant comparison.ResultsTwenty-five interviews were conducted in ten relatives. Relatives believed that physical activity in the ICU improves recovery. Participating in physical activity decreased their feelings of powerlessness and uselessness. Relatives mentioned that they would be stimulated to participate if they were invited, guided and informed by healthcare providers. The perceived reticence of healthcare providers, patient's health-changing capacity and the inability to communicate led to a more passive attitude towards participation.ConclusionsThe conceptual model shows how family participation during physical activity changes from a passive role, with negative beliefs and feelings of uselessness and powerlessness, to a more proactive participatory role. Relatives felt more useful and like they were part of the team. Providing relatives with additional information might be a viable strategy to help and stimulate participation.     

Family participation in essential care activities: Needs,perceptions, preferences,and capacities of intensive care unit patients,relatives, and healthcare providers—An integrative review

BackgroundFamily participation in essential care activities may benefit both patients and relatives.ObjectivesIn this integrative review, we aimed to identify needs, perceptions, preferences, and capacities regarding family participation in essential care in intensive care units (ICUs) from the patient's, relatives', and ICU healthcare providers' perspective.Review method usedAn integrative review method was used.Data sourcesPubMed, CINAHL, EMBASE, MEDLINE, Cochrane, Web of Science, and reference lists of included articles were searched, from inception to January 25, 2021.Review methodsWe included studies on family participation in essential care activities during ICU stay which reported associated needs, perceptions, preferences and capacities. Quality assessment was performed with the Kmet Standard Quality Assessment Criteria developed for evaluating primary research papers in a variety of fields, and an extensive qualitative thematic analysis was performed on the results.ResultsTwenty-seven studies were included. Quality scores varied from 0.45 to 0.95 (range: 0–1). Patients’ needs, perceptions, preferences, and capacities are largely unknown. Identified themes on needs and perceptions were relatives' desire to help the patient, a mostly positive attitude among all involved, stress regarding patient safety, perceived beneficial effects, relatives feeling in control—ICU healthcare providers' concerns about loss of control. Preferences for potential essential care activities vary. Relatives want an invitation and support from ICU healthcare providers. Themes regarding capacities were knowledge, skills, education and training, and organisational conditions.ConclusionsImplementation of family participation in essential care requires education and training of relatives and ICU healthcare providers to address safety and quality of care concerns, though most studies lack further specification.     

The use and usefulness of ICU diaries to support family members of critically ill patients

PurposeTo analyze and describe the use and usefulness of the ICU diary to support family members of critically ill patients.Materials and methodsA socio-technical systems model (SEIPS 2.0) guided data collection and analysis in this study aimed to gain a holistic understanding of factors that shape ICU diary processes and family requirements for support. Triangulated data sources, including interviews, observations, and photographs, were content analyzed for person, task, tool, and context attributes determining the use and usefulness of ICU diaries. Researchers recruited family members of critically ill patients admitted to ICUs in two hospitals (urban, rural) in the southeastern United States.ResultsNineteen female (100%) family members participated in this study. ICU diaries were used and adapted by family members to cope with the ICU experience in multiple ways. Results indicate that staff support, easy access, embedded instructional format, early initiation, and family ownership facilitated ICU diary use by family members. The ICU diary was useful as a medium to process emotions and gain insights, reduce stress, track information, and communicate with the staff and the patient.ConclusionsThe ICU diary is useful to family members as a stress reduction, information management, and communication tool. The design of ICU diary implementations must address system factors to assure family members receive benefits from diary use. Further research is needed to expand our understanding of the optimal structure, process, and content of ICU diary implementations.     

Información a familiares de pacientes en proceso final de vida en unidades de cuidados intensivos. Evaluación por parte de las enfermeras

IntroductionInforming is a process that includes many aspects and when it involves a family member at the end of life it becomes a complicated matter, not only for giving the information, but also for the mood of family members. Thus, the information should be adapted to the language and education of the patient and family. That information must be proper and suitable to the moment.ObjectiveTo describe the aspects of information offered to relatives of patients in the end of life process in Intensive Care Units (ICU), and to determine the nursing evaluation in this process. To evaluate the professionals’ attitude on this subject.Material and methodAn observational study conducted on nurses in pediatric and adult ICU nurses of a large public health hospital complexes in the city of Madrid. The data was collected using a questionnaire on the evaluation of care of children who died in pediatric ICU.ResultsThe majority of the nurses, 71% (159), said that the information was given in a place alone with the doctor. More than half (52.4%, 118) considered that the information was sufficient/insufficient depending on the day. Significant differences were found as regards the behavior of the staff at the time of a death in (P < .01), with pediatric ICU professionals being more empathetic.ConclusionsICU nurses believe that the information is appropriate for the prognosis and adapted to the patient situation. They also consider the place where the information is given and the attitude of the professionals in the end of life process are adequate.     

Important clinician information needs about family members in the intensive care unit

PurposeClinicians often lack key information regarding intensive care unit (ICU) families. Our objective was to identify (1) important information for clinicians to know about ICU families when making decisions and (2) important information for families to know about patients from clinicians.Materials and methodsWe identified important information items through a literature review and semistructured interviews. A separate cohort of family members, nurses, and physicians from 2 ICUs in a single institution were asked to prioritize the identified information as necessary for decision making.ResultsWe identified 21 items important for clinicians to know about families and 32 items important for families to know about patients from clinicians. Themes important for clinicians to know about family members included family background, questions, understanding, goals, concerns, well-being, and requests for additional help. Themes important for families to know about the patient included diagnosis, treatments, prognosis, clinical status, schedule, comfort, goals of care, medical team, and family participation.ConclusionsThrough qualitative and quantitative analysis, we identified important information for ICU clinicians to know about family members and for family members to know about patients. The identified information can be used to guide strategies and tools to improve assessment of and communication with families.     

Criteria deemed important by the relatives for designating a reference person for patients hospitalized in ICU

PurposeWe investigated the criteria that patients' relatives deem important for choosing, among themselves, the person best qualified to interact with the caregiving staff.MethodsExploratory, observational, prospective, multicentre study between 1st March and 31st October 2018 in 2 intensive care units (ICUs). A 12-item questionnaire was completed anonymously by family members of patients hospitalized in the ICU 3 and 5 days after the patient's admission. Relatives were eligible if they understood French and if no surrogate had been appointed by the patient prior to ICU admission. More than one relative per patient could participate.ResultsIn total, 87 relatives of 73 patients completed the questionnaire, average age of relatives was 58 ± 15 years, 46% were the spouse, 30% were children/grandchildren. Items classed as being the most important attributes for a reference person were: good knowledge of the patient's wishes and values; an emotional attachment to the patient; being a family member; and having an adequate understanding of the clinical status and clinical history.ConclusionThis study identifies the attributes considered by relatives to be most important for designating, among themselves, a reference person for a patient hospitalized in the ICU.     

A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit

BackgroundPartnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically.ObjectiveThe objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU).MethodsA retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from “poor” (0) to “excellent” (100).ResultsIn total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients’ treatment in the ICU and appreciation for the care, skill, and professionalism of the staff.ConclusionVery high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.     

ICU病人亲属家庭需要的调查研究

应用Molter“急危重病人家庭需要量表”对 5 0例ICU病人亲属进行调查 ,以了解当病人在ICU接受监护时 ,其亲属对病人家庭需要的认识。结果显示ICU病人亲属认为能够保证病人的安全 ,了解病人的治疗与预后 ,了解病人护理的需要最重要 ,而与病人亲属身心相关的需求重要性得分则较低。某些需要在男女病人亲属之间存在显著性差异 ,部分需要与病人亲属的年龄、教育水平和家庭收入分别有显著相关。提示ICU护士必须正确认识病人家庭需要 ,并根据病人亲属的性别、年龄、教育水平和家庭收入等因素满足病人家庭需要 ,以帮助病人家庭应对病人病重时的危机状态 ,维持病人及亲属的身心健康     

Necesidades y estrategias de participación propuestas por la familia en los cuidados diarios del paciente crítico

IntroductionThe continuous and technical assistance that the critical patient requires sometimes produces a barrier with the family, generating the alteration of their needs. Family involvement is beneficial to both the family and the patient.Objective1) Knowing the feelings and needs of the patients’ relative admitted to an ICU of a third level hospital in Catalonia and 2) To study the participation strategies proposed by the relatives.MethodsPhenomenological qualitative study. The sample population selected was the patients’ relatives admitted to an UCI of a 3rd level Catalan hospital from May 2017 to February 2018. The sampling was intentional, considering different typologies to guarantee the diversity of the discourse. Semi-structured interviews were conducted, analyzed thematically. The rigor criteria of Guba and Lincoln were applied.Results15 relatives were interviewed. The participants express negative, positive and transformative feelings. Psychological assistance, having more information and collaborating in the care of your family member are some of the expressed needs. Among the strategies proposed in the absence of care participation is the increase in family hours in the ICU and the support of a nurse educator care.ConclusionsIt is necessary to reorient the personnel practice incorporating strategies that further integrate the family in the daily care of the critically ill patient. Helping the family, prioritizing their needs and guiding them in learning is basic and part of the professional care.     

Perspectives of Family Members on Planning End-of-Life Care for Terminally Ill and Frail Older People

ContextAdvance care planning (ACP) is the process by which patients, together with their physician and loved ones, establish preferences for future care. Because previous research has shown that relatives play a considerable role in end-of-life care decisions, it is important to understand how family members are involved in this process.ObjectivesTo gain understanding of the involvement of family members in ACP for older people near the end of life by exploring their views and experiences concerning this process.MethodsThis was a qualitative research study, done with semistructured interviews. Twenty-one family members were recruited from three geriatric settings in Flanders, Belgium. The data were analyzed using the constant comparative method as proposed by the grounded theory.ResultsFamily members took different positions in the ACP process depending on how much responsibility the family member wanted to take and to what extent the family member felt the patient expected him/her to play a part. The position of family members on these two dimensions was influenced by several factors, namely acknowledgment of the imminent death, experiences with death and dying, opinion about the benefits of ACP, burden of initiating conversations about death and dying, and trust in health care providers. Furthermore, the role of family members in ACP was embedded in the existing relationship patterns.ConclusionThis study provides insight into the different positions of family members in the end-of-life care planning of older patients with a short life expectancy. It is important for health care providers to understand the position of a family member in the ACP of the patient, take into account that family members may experience an active role in ACP as burdensome, and consider existing relationship patterns.     

结核病监护室患者家属需求的差异性分析

目的 了解结核病监护室（tubercular ICU，TICU）患者家属需求状况的差异性。方法采用问卷调查的方法，随机调查60例TICU患者家属和60例综合ICU患者家属。结果TICU患者家属认为有关结核病防治、情感支持的需要明显高于综合ICU患者家属。其中有关结核病防治的需要与TICU患者家属的年龄、收入水平和文化程度分别显著相关。结论TICU护士应理解和重视患者家属的心理需求，及时与家属沟通有关信息，并根据家属的年龄、收入水平、文化程度的不同做好其自身的结核病防治，消除和减轻其不良心理，维持患者和家属的身心健康，以更好地发挥TICU患者家属对患者的正性支持作用。     

Posttraumatic stress disorder in close Relatives of Intensive Care unit patients’ Evaluation (PRICE) study

BackgroundThere is a high risk of post-traumatic stress disorder (PTSD) in relatives of intensive care unit (ICU) patients.AimsTo determine the prevalence and predictors of symptoms of PTSD in relatives of an Australian critically ill population.Methods108 consecutive patients staying >48 h in a mixed, level three ICU were identified. On day three of admission, their next-of-kin were contacted and consent obtained for a telephonic questionnaire to be done at 90 days after ICU discharge. This consisted of the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised (IES-R) questionnaires administered to relatives at 90 days post-discharge from the ICU. An IES-R score of >26 was used to define PTSD symptoms.ResultsEight subjects were excluded because the next-of-kin details were unavailable. 37 other subjects refused to participate. Out of a total of 108, 63 family members were included, including 49 next-of-kin of patients who survived. The prevalence of PTSD symptoms was 41.2% (26/63, 95% CI 29.0–54.4%). The anxiety score was found to be a predictor of PTSD symptoms (relative risk = 1.07; 95% CI 1.00–1.14, p = 0.05).ConclusionThere is a high prevalence of PTSD symptoms in next-of-kin of Australian patients admitted to the ICU. High anxiety scores were a predictor for developing PTSD symptoms.     

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.     

Experiences of family members of elderly patients in the emergency department: A qualitative study

BackgroundElderly patients are more frequent users of emergency department (ED). An elderly patient entering the ED is often accompanied by a family member who has an important role in the patient’s life. Current literature does not adequately address the question of the experiences of family members accompanying elderly patient in ED, although they could give us valuable and interesting knowledge and information about nursing practices.AimThe aim of this study was to describe the experiences of family members of elderly patients aged over 65 in the ED for internal medicine.MethodThis interview study based on the experiences of family members (n = 9) of elderly patients being cared for in the ED. The interview material was analyzed using inductive content analysis.ResultsFamily members of elderly patients perceived themselves as satisfied participants, invisible participants, or disappointed outsiders in the ED. Family members accompanying an elderly patient wanted to be active participants not being excluded, but this was possible only because of their own active attitude.ConclusionsBroader educational initiative for ED staff about the family presence and involvement in care in the ED is needed, because the family members’ experiences showed that they were left as outsiders. Family members are well aware of the elderly patient’s previous level of functional capacity and their medication, which is decisive information when planning further care and thinking patients coping at home.     

A family intervention to reduce delirium in hospitalised ICU patients: A feasibility randomised controlled trial

BackgroundFamily members could play an important role in preventing and reducing the development of delirium in Intensive Care Units (ICU) patients. This study sought to assess the feasibility of design and recruitment, and acceptability for family members and nurses of a family delivered intervention to reduce delirium in ICU patients.MethodA single centre randomised controlled trial in an Australian medical/surgical ICU was conducted. Sixty-one family members were randomised (29 in intervention and 32 in non-intervention group). Following instructions, the intervention comprised the family members providing orientation or memory clues (family photographs, orientation to surroundings) to their relative each day. In addition, family members conducted sensory checks (vision and hearing with glasses and hearing aids); and therapeutic or cognitive stimulation (discussing family life, reminiscing) daily. Eleven ICU nurses were interviewed to gain insight into the feasibility and acceptability of implementing the intervention from their perspective.ResultsRecruitment rate was 28% of eligible patients (recruited n = 90, attrition n = 1). Following instruction by the research nurse the family member delivered the intervention which was assessed to be feasible and acceptable by family members and nurses. Protocol adherence could be improved with alternative data collection methods. Nurses considered the activities acceptable.ConclusionThe study was able to recruit, randomise and retain family member participants. Further strategies are required to assess intervention fidelity and improve data collection.     

Medical Oversight,Educational Core Content,and Proposed Scopes of Practice of Wilderness EMS Providers: A Joint Project Developed by Wilderness EMS Educators,Medical Directors,and Regulators Using a Delphi Approach

Introduction: A disparity exists between the skills needed to manage patients in wilderness EMS environments and the scopes of practice that are traditionally approved by state EMS regulators. In response, the National Association of EMS Physicians Wilderness EMS Committee led a project to define the educational core content supporting scopes of practice of wilderness EMS providers and the conditions when wilderness EMS providers should be required to have medical oversight. Methods: Using a Delphi process, a group of experts in wilderness EMS, representing educators, medical directors, and regulators, developed model educational core content. This core content is a foundation for wilderness EMS provider scopes of practice and builds on both the National EMS Education Standards and the National EMS Scope of Practice Model. These experts also identified the conditions when oversight is needed for wilderness EMS providers. Results: By consensus, this group of experts identified the educational core content for four unique levels of wilderness EMS providers: Wilderness Emergency Medical Responder (WEMR), Wilderness Emergency Medical Technician (WEMT), Wilderness Advanced Emergency Medical Technician (WAEMT), and Wilderness Paramedic (WParamedic). These levels include specialized skills and techniques pertinent to the operational environment. The skills and techniques increase in complexity with more advanced certification levels, and address the unique circumstances of providing care to patients in the wilderness environment. Furthermore, this group identified that providers having a defined duty to act should be functioning with medical oversight. Conclusion: This group of experts defined the educational core content supporting the specific scopes of practice that each certification level of wilderness EMS provider should have when providing patient care in the wilderness setting. Wilderness EMS providers are, indeed, providing health care and should thus function within defined scopes of practice and with physician medical director oversight.     

An evaluation of learning clinical decision-making for early rehabilitation in the ICU via interactive education with audience response system

Purpose: Knowledge-related barriers to safely implement early rehabilitation programs in intensive care units (ICUs) may be overcome via targeted education. The purpose of this study was to evaluate the effectiveness of an interactive educational session on short-term knowledge of clinical decision-making for safe rehabilitation of patients in ICUs.

Method: A case-based teaching approach, drawing from published safety recommendations for initiation of rehabilitation in ICUs, was used with a multidisciplinary audience. An audience response system was incorporated to promote interaction and evaluate knowledge before vs. after the educational session.

Results: Up to 175 audience members, of 271 in attendance (129 (48%) physical therapists, 51 (19%) occupational therapists, 31 (11%) nursing, 14 (5%) physician, 46 (17%) other), completed both the pre- and post-test questions for each of the six unique patient cases. In four of six patient cases, there was a significant (p< 0.001) increase in identifying the correct answer regarding initiation of rehabilitation activities. This learning effect was similar irrespective of participants’ years of experience and clinical discipline.

Conclusions: An interactive, case-based, educational session may be effective for increasing short-term knowledge, and identifying knowledge gaps, regarding clinical decision-making for safe rehabilitation of patients in ICUs.

• Implications for Rehabilitation

• Lack of knowledge regarding the safety considerations for early rehabilitation of ICU patients is a barrier to implementing early rehabilitation.

• Interactive educational formats, such as the use of audience response systems, offer a new method of teaching and instantly assessing learning of clinically important information.

• In a small study, we have shown that an interactive, case-based educational format may be used to effectively teach clinical decision-making for the safe rehabilitation of ICU patients to a diverse audience of clinicians.