A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses

Breanna Hetland, Natalie McAndrew, Joseph Perazzo, Ronald Hickman, Breanna Hetland, Natalie McAndrew, Joseph Perazzo, Ronald Hickman

Abstract

Objective: Family caregiver involvement may improve patient and family outcomes in the intensive care unit. This study describes critical care nurses' approaches to involving family caregivers in direct patient care.

Research methodology & design: This is a qualitative content analysis of text captured through an electronic survey.

Setting: A convenience sample of 374 critical care nurses in the United States who were subscribers to one of the American Association of Critical Care Nurses social media sites or electronic newsletters.

Main outcome measure: Critical care nurses' responses to five open-ended questions about their approaches to family involvement in direct patient care.

Findings: Nurse, patient and family caregiver factors intersected in the context of the professional practice environment and the available resources for family care. Two main themes were identified: "Involving family caregivers in patient care in the intensive care unit requires careful ssessment" and "There are barriers and facilitators to caregiver involvement in patient care in the intensive care unit."

Conclusion: Patient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research.

Keywords: Caregiver; Critical care; Engagement; Family; Intensive Care Unit; Involvement; Patient care.

Conflict of interest statement

Conflict of Interest Statement: The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Copyright © 2017 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Interaction Between Barriers and Facilitators and Their Influence on Family Involvement

References

    1. Al-Mutair AS, Plummer V, O’Brian AP, Clerehan R. Attitudes of healthcare providers towards family involvement and presence in adult critical care units in Saudi Arabia: A quantitative study. J Clin Nurs. 2013a Mar;(23):744–755.
    1. Al-Mutair AS, Plummer V, O’Brien A, Clerehan R. Family needs and involvement in the intensive care unit: A literature review. J Clin Nurs. 2013b;22(13–14):1805–1817.
    1. Anderson WG, Arnold RM, Angus DC, Bryce CL. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med. 2008;23(11):1871–1876.
    1. Brown SM, Rozenblum R, Aboumatar H, Fagan MB, Milic M, Sarnoff Lee B, Turner K, Frosch DL. Defining patient and family engagement in the intensive care unit. Am J Respir Crit Care Med. 2015;191(3):358–360.
    1. Cameron JI, Herridge MS, Tansey CM, McAndrews MP, Cheung AM. Well-being in informal caregivers of survivors of acute respiratory distress syndrome. Crit Care Med. 2006;34(1):81–86.
    1. Cameron JI, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, Friedrich JO, Mehtra S, Lamontagne F, Levasseur M, Ferguson ND, Adhikari NKJ, Rudkowski JC, Meggison H, Skrobik Y, Flannery J, Bayley M, Batt J, dos Santos C, Abbey SE, Tan A, Lo V, Mathur S, Parotto M, Morris D, Flockhart L, Fan E, Lee CM, Wilcox ME, Ayas N, Choong K, Fowler R, Scales DC, Sinuff T, Cuthbertson BH, Rose L, Robles P, Burns S, Cypel M, Singer L, Chaparro C, Chow CW, Keshavjee S, Brochard L, Hébert P, Slutsky AS, Marshall JC, Cook D, Herridge MS for the RECOVER Program Investigators (Phase 1: towards RECOVER and the Canadian Critical Care Trials Group) One-year outcomes in caregivers of critically ill patients. N Engl J Med. 374(19):1831–1841.
    1. Choi J, Donahoe MP, Zullo TG, Hoffman LA. Caregivers of the chronically critically ill after discharge from the intensive care unit: Six months’ experience. Am J Crit Care. 2011;20(1):12–23.
    1. Davidson JE, Powers K, Medayat KM, Tieszen M, Kon AA, Shepard E, Spuhler V, Todres ID, Levy M, Barr J, Ghandi R, Hirsch G, Armstrong D American College of Critical Care medicine Task Force 2004–2005 Society of Critical Care Medicine. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Crit Care Med. 2007;35(2):605–622.
    1. Davidson JE, Asiakson RA, Long A, Puntillo KA, Kross EK, Hart J, Cox C, Wunsch H, Wickline MA, Nunnally ME, Netzer G, Kentish-Barnes N, Sprung C, Hartog CS, Coombs M, Gerritsen RT, Hopkins RO, Franck LS, Skrobik Y, Kon A, Scruth EA, Harvey MA, Lewis-Newby M, White DB, Swoboda SM, Cooke CR, Levy M, Azoulay E, Curtis JR. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med. 2017;45(1):103–128.
    1. Dinç L, Gastmans C. Trust in nurse-patient relationships: A literature review. Nurs Ethics. 2013;20(5):501–516.
    1. Douglas S, Daly B. Caregivers of long-term ventilator patients. CHEST. 2003;123:1073–1081.
    1. Eggenberger SK, Sanders M. A family nursing education intervention supports nurses and families in an adult intensive care unit. Aust Crit Care. 2016;29:217–233.
    1. El-Masri MM, Fox-Wasylyshyn SM. Nurses’ roles with families: Perceptions of ICU nurses. Intensive Crit Care Nurs. 2007;23:43–50.
    1. Fry S, Warren NA. Perceived needs of critical care family members. Critical Care Nurs Q. 2007;30(2):181–188.
    1. Ganz FD, Yoffe F. Intensive care nurses’ perspectives of family-centered care and their attitudes toward family presence during resuscitation. J Cardiovasc Nurs. 2012;27(3):220–227.
    1. Garrouste-Orgeas M, Millems V, Timsit JF, Diaw F, Brochon S, Vesin A, Philippart F, Tabah A, Coquet Il Bruel C, Moulard ML, Carlet J, Misset B. Opinions of families, staff, and patients about family participation in care in intensive care units. J Crit Care. 2010;25:634–640.
    1. Hammond F. Involving families in care within the intensive care environment: A descriptive survey. Intensive Crit Care Nurs. 1995;1:256–264.
    1. Hetland B, Hickman R, McAndrew N, Daly B. Factors that influence active family engagement in care among critical care nurses. AACN Adv Crit Care. 2017;28(2):160–170.
    1. Hickman R, Douglas S. Impact of chronic critical illness on the psychological outcomes of family members. AACN Adv Crit Care. 2010;21(1):80–90.
    1. Hsieh H, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–1288.
    1. Hupcey JE. Looking out for the patient and ourselves—the process of family integration into the ICU. J Clin Nurs. 1999;8:253–262.
    1. Institute for Patient- and Family-Centered Care. Better Together: Partnering with Families. [accessed 20.11.16];Facts and Figures about Family Presence and Participation. .
    1. Johnson P, Chaboyer W, Foster M, van der Vooren R. Caregivers of ICU patients discharged home: What burden do they face? Intensive Crit Care Nurs. 2001;17:219–227.
    1. Liput SA, Kane-Gill SL, Seybert AL, Smithburger PL. A review of the perceptions of healthcare providers and family members toward family involvement in active adult patient care in the ICU. Crit Care Med. 2016;44(6):1191–1197.
    1. McConnell B, Moroney T. Involving relatives in ICU patient care: Critical care nursing challenges. J Clin Nurs. 2015;24:991–998.
    1. Mitchell M, Chaboyer W, Burmeister E, Foster M. Positive effects of a nursing intervention on family-centered care in adult critical care. Am J Crit Care. 2009;18:543–553.
    1. Mitchell M, Coyer F, Kean S, Stone R, Murfield J, Dwan T. Patient, family-centered care interventions within the adult ICU setting: An integrative review. Aust Crit Care. 2016;29:179–193.
    1. Nelms TP, Eggenberger SK. The essence of the family critical illness experience and nurse-family meetings. J Fam Nurs. 2010;16(4):462–486.
    1. Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and family involvement in adult critical and intensive care settings: A scoping review. [accessed 6.10.16];Health Expectations. 2015 .
    1. Segaric CA, Hall WA. Progressively engaging: Constructing nurse, patient, and family relationships in acute care settings. J Fam Nurs. 2015;21(1):35–56.
    1. Society of Crit Care Med. [accessed 14.2.17];Critical Care Statistics. 2017 Retrieved from .
    1. Tyrie LS, Mosenthal AC. Care of the family in the surgical intensive care unit. Anesthesiol Clin. 2012;30:37–46.
    1. Van Pelt DC, Milbrandt EB, Weissfeld LA, Rotondi AJ, Schulz R, Chelluri L, Angus DC, Pinsky MR. Informal caregiver burden among survivors of prolonged mechanical ventilation. Am J Respir Crit Care Med. 2007;175(2):167–173.

Source: PubMed

3
Iratkozz fel