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The needs and satisfaction levels of family members of critically ill patients have received much attention in the literature. The feelings of family members, however, have not been thoroughly investigated. To develop appropriate nursing... more
The needs and satisfaction levels of family members of critically ill patients have received much attention in the literature. The feelings of family members, however, have not been thoroughly investigated. To develop appropriate nursing interventions to assist family members in coping with a critical care hospitalization, accurate information about their emotional response to the situation is needed. To examine emotional responses of family members and their descriptions of supportive behaviors of others during a critical care hospitalization. An exploratory design was used to study 52 subjects with critically ill family members in the pediatric, neonatal, medical, surgical and cardiovascular intensive care units in a large tertiary care hospital. The subjects kept daily logs of their feelings and the supportive behaviors of others. Thematic analysis was used to identify major themes. Analysis revealed a broad range of powerful emotions throughout the intensive care unit stay. Negative and positive emotions such as despair and joy were sometimes identified by subjects within a 24-hour period. Although fear, worry, anger and exhaustion were dominant themes during the first 24 hours and when the family received bad news about the patient, there was no pattern of emotional response evident as the stay progressed. Some differences between subjects drawn from the medical and neonatal intensive care units were evident. The findings suggest that family members of critically ill patients experience deep emotional turmoil throughout the intensive care unit stay. Specific nursing interventions to promote adaptive coping are needed throughout the experience.
Research Interests: Nursing, Family, Social Support, Adolescent, Critical Care, and 9 moreEmotions, Humans, Female, Male, American, Aged, Middle Aged, Adult, and Intensive Care Units
Coronary artery bypass surgery patients often rely on spouses for assistance during recovery. Caregiving may be stressful, adversely affecting caregiver physical and emotional health and, therefore, ability to provide care. This... more
Coronary artery bypass surgery patients often rely on spouses for assistance during recovery. Caregiving may be stressful, adversely affecting caregiver physical and emotional health and, therefore, ability to provide care. This cross-sectional correlational study investigated factors associated with caregiver depressive symptoms, outcomes, and perceived physical health. Using a model from existing theories, these dependent variables were considered "health-related quality of life" outcomes. A convenience sample of 166 coronary artery bypass spouse caregivers completed surveys on patient health status, caregiver personality and relationship factors, task difficulty, depressive symptoms, caregiver outcomes, and perceived physical health. Using regression analysis, worse patient proxy health ratings and less personal mastery were associated with greater caregiver depressive symptoms. Being a female caregiver, worse patient proxy health ratings, lower mutuality, and more caregiver depressive symptoms were associated with negative caregiver outcomes. Younger spousal age and worse patient proxy health ratings were associated with worse caregiver perceived physical health. Although further longitudinal investigations are recommended, findings suggest that helping coronary artery bypass spouse caregivers master their role, improve their relationship with the patient, and avoid or reduce depressive symptoms can improve caregiver outcomes and are therefore areas for possible intervention.
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This study examined the hospital-wide effect of a mandatory 8-hour nurse preceptor workshop on preceptors and orientees. A mixed-methods approach was used. The quantitative surveys were augmented with qualitative short-answer questions... more
This study examined the hospital-wide effect of a mandatory 8-hour nurse preceptor workshop on preceptors and orientees. A mixed-methods approach was used. The quantitative surveys were augmented with qualitative short-answer questions (QUAN + qual) to identify the perceptions of preceptorship experiences for both preceptors and orientees. Findings from the narrative portions of the survey are presented. Orientees were able to distinguish between poor and excellent quality in precepting, were concerned that orientation was not tailored to the needs of experienced nurses, and described three to four preceptors as being the ideal number to be assigned to an orientee. Preceptors postintervention described "being more open" to the orientee's view, "slowing down," and increasing the promotion of critical thinking strategies. According to the quantitative results, orientees postintervention did not report increased satisfaction with preceptors. Qualitative findings suggested that this was likely related to a high number of preceptors, heavy patient loads, and lack of tailoring of orientation to the needs of experienced nurses. The quantitative results showed that preceptors postintervention reported increased satisfaction and confidence for precepting in all five preceptor roles assessed quantitatively; qualitative findings further supported these findings. However, narrative findings indicated that a primary barrier to positive changes in a preceptor's practice was a heavy patient load while precepting.
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Ongoing wound assessment is essential to track the progress or lack of progress of non-healing wounds treated with HBO. By incorporating the entire HBO team, the assessment tool encourages clinicians to take a comprehensive view of the... more
Ongoing wound assessment is essential to track the progress or lack of progress of non-healing wounds treated with HBO. By incorporating the entire HBO team, the assessment tool encourages clinicians to take a comprehensive view of the patient's physiological status and progress toward desired outcomes. Clinical assessment tools are a useful method to monitor and document the effectiveness of HBO as an adjunctive therapy to wound healing. As a result, other treatment measures that are also beneficial for wound healing can be included in the patient's plan of care.
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Various interventions may be used by nurses to provide social support to critical care families. Nurses may support family members in one-to-one relationships, or by facilitating the development of supportive relationships in the group... more
Various interventions may be used by nurses to provide social support to critical care families. Nurses may support family members in one-to-one relationships, or by facilitating the development of supportive relationships in the group setting. The steps described here are fundamental in developing a support group for family members of adults hospitalized in a surgical ICU to meet their predetermined needs. The support needs of family members and the timing of a support group during the critical care phase must first be validated. Once this assessment is completed, the support group may be based on the educational model, mutual-peer support model, educational-mutual support model, or ventilation model. The group model selected will provide direction to the structure, membership, and leadership of the support group. Regardless of the model considered appropriate for the needs of the family population and setting, critical care nurses need to evaluate the impact of the support group on the psychologic health of the family. The four different group perspectives clearly illustrate the need for nurses to determine what types of support are needed or are most beneficial for families during various phases of illness. Perhaps family members benefit from sharing and camaraderie during the acute or critical care phase, whereas educational support groups are more effective in reviewing illness and treatment implications after the immediate threat of the illness has passed. Findings from these evaluation studies will assist nurses in shaping intervention strategies for critical care family members in clinical practice.
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To examine the behavioral and emotional responses of the child and of the nonhospitalized adult family member (NHAFM) to facilitated child visitation in the critical care setting. Quasi-experimental, posttreatment design. An adult... more
To examine the behavioral and emotional responses of the child and of the nonhospitalized adult family member (NHAFM) to facilitated child visitation in the critical care setting. Quasi-experimental, posttreatment design. An adult surgical intensive care unit at a large Midwestern teaching hospital. Twenty families participated in the study, 10 families in a restricted and 10 families in a facilitated visitation group. Each family unit had a child, an NHAFM, and a critically ill family member. In the control group the NHAFMs visited the patient in the customary routine, but children were restricted from visiting. After a 2-week waiting period a facilitated child visitation intervention was implemented for the experimental group. The child completed measures on anxiety as measured by the Manifest Anxiety Scale and behavioral and emotional changes as measured by the Perceived Change Scale. The NHAFM completed measures on anxiety as measured by the State-Trait Anxiety Inventory and mood as measured by the Mood Adjective Check List. Family functioning, as measured by the Feetham Family Functioning Survey, and life event changes, as measured by the Life Event Scale, were examined as extraneous variables. The Child Visitation Intervention encompassed systematic facilitation and supervision of children visiting a critically ill adult family member in a surgical intensive care unit and provision of emotional support before, during, and after visitation (the intervention protocol may be obtained from the investigators on request). Children in the facilitated visitation group had a greater reduction (t = 4.0, df = 18, p = 0.0004) in negative behavioral and emotional changes as measured by the Child-Perceived Change Scale when compared with children in the restricted visitation group. Facilitated child visitation may help children deal with the critical illness of an adult family member and deserves further study.
Research Interests: Nursing, Family, Systems Theory, Adolescent, Teaching, and 19 moreAnxiety, Humans, Child, Models, Psychological, Female, Male, Child Psychology, Heart, Organizational Policy, Aged, Middle Aged, Questionnaires, Adult, ANXIETY, Intensive Care Units, Psychological Models, Pilot Projects, and Life Change Events
Elimination for the spinal cord-injured patient presents a challenge to nurses in both the acute and rehabilitation phases. The most frequent GI and urinary complications associated with spinal shock are gastric dilatation and paralytic... more
Elimination for the spinal cord-injured patient presents a challenge to nurses in both the acute and rehabilitation phases. The most frequent GI and urinary complications associated with spinal shock are gastric dilatation and paralytic ileus, stress ulcers, metabolic disturbances, and neurogenic bowel and bladder. Associated clinical findings are often altered or absent from the lack of sensory, motor, and reflex functions. Nonspecific signs and symptoms such as anorexia, nausea, and vomiting, create the need for complex differential diagnosis. Critical care nurses have a vital role in this diagnostic process by monitoring and reporting significant changes in assessment and laboratory findings. In addition, care measures are directed at preventing complications or supporting the patient's current condition. These interventions include gastric decompression, gastric pH monitoring, administration of antacids, nutritional support, and early bowel and bladder management.
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The continuing evolution of the highly specialized, technologic manner in which we provide care in critical care units has potentially hazardous effects on the physical and psychological well-being of patients and family members. Although... more
The continuing evolution of the highly specialized, technologic manner in which we provide care in critical care units has potentially hazardous effects on the physical and psychological well-being of patients and family members. Although the ICU environment possesses characteristics that make patients and families prone to undesirable sequelae, critical care nurses can employ creative strategies to minimize the impact of bedside technology that is so important for the survival and recovery of the critically ill patient. Strategies to reduce the psychological impact of the ICU environment begin with a psychosocial assessment of the meaning patients and families attach to bedside technology. This assessment will strengthen nurse, patient, and family interactions, as well as guide patient and family education and sensory information to reduce fear and anxiety often associated with threatening procedures. Facilitating touch and family involvement in the patient's care during visitation is another strategy to humanize the technologic environment. Managing the environment is essential to reduce the physical impact of the ICU environment. Nurses can manipulate the use of equipment to reduce crowding and noise at the bedside, foster familiar activities to stimulate the patient's other senses, and facilitate sleep patterns by structuring nursing activities and providing comfort measures. These nursing interventions will reduce the effects of sensory overload/deprivation and sleep deprivation and, it is hoped, prevent ICU psychosis.
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Patient satisfaction has become an important indicator to measure the quality of care. Nursing has long used outcome measures to evaluate health care. The study assessed the patient satisfaction of patients from medical and surgical units... more
Patient satisfaction has become an important indicator to measure the quality of care. Nursing has long used outcome measures to evaluate health care. The study assessed the patient satisfaction of patients from medical and surgical units at a teaching hospital of southern Taiwan. Of the 806 near-discharge patients from medical or surgical units approached to participate in the study, a total of 477 patients returned questionnaires for a response rate of 59%. The total mean score for all the patients' satisfaction score was 4.28 (SD = 0.53). In general it reflected that the patients were satisfied. There was no significant difference between the patient demographic variables, primary nurse's age, marriage, and total working experience on any of the subscales. Results of this study provided evidence that primary nurse's unit working experience can influence patient satisfaction (P value < .05).
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ABSTRACT
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Hospitalization for a critical illness is not only a crisis for the patient, but also his family. This annotated bibliography can be used as a resource for nurses dealing with the family members of such patients.
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Due to the dynamic nature of QA, the indicators for the critical care nursing division will continue to change in response to societal, professional, and individual values, as well as to advances in scientific knowledge. Perhaps the... more
Due to the dynamic nature of QA, the indicators for the critical care nursing division will continue to change in response to societal, professional, and individual values, as well as to advances in scientific knowledge. Perhaps the latter will present the greatest challenge to the CNS, whose direct and indirect roles influence the quality of care in the critical care setting.
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Gastrointestinal problems, with an incidence of about 1%, may complicate the postoperative period after cardiovascular surgery, increasing morbidity, length of stay, and mortality. Several risk factors for the development of these... more
Gastrointestinal problems, with an incidence of about 1%, may complicate the postoperative period after cardiovascular surgery, increasing morbidity, length of stay, and mortality. Several risk factors for the development of these complications, including preexisting conditions; advancing age; surgical procedure, especially valve, combined bypass/valve, emergency, reoperative, and aortic dissection repair; iatrogenic conditions; stress; ischemia; and postpump complications, have been identified in multiple research studies. Ischemia is the most significant of these risk factors after cardiovascular surgery. Mechanisms that have been implicated include longer cardiopulmonary bypass and aortic cross-clamp times and hypoperfusion states, especially if inotropic or intra-aortic balloon pump support is required. These risk factors have been linked to upper and lower gastrointestinal bleeding, paralytic ileus, intestinal ischemia, acute diverticulitis, acute cholecystitis, hepatic dysfunction, hyperamylasemia, and acute pancreatitis. Gastrointestinal bleeding accounts for almost half of all complications, followed by hepatic dysfunction, intestinal ischemia, and acute cholecystitis. Identification of these gastrointestinal complications may be difficult because manifestations may be masked by postoperative analgesia or not reported by patients because they are sedated or require prolonged mechanical ventilation. Furthermore, clinical manifestations may be nonspecific and not follow the "classic" clinical picture. Therefore, astute assessment skills are needed to recognize these problems in high-risk patients early in their clinical course. Such early recognition will prompt aggressive medical and/or surgical management and therefore improve patient outcomes for the cardiovascular surgical population.
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In this article, the authors describe ways to create spirit at work--a sense of teamwork and caring for patients, their families, and colleagues. Defining an ideal role model and striving to emulate that model are the first steps to... more
In this article, the authors describe ways to create spirit at work--a sense of teamwork and caring for patients, their families, and colleagues. Defining an ideal role model and striving to emulate that model are the first steps to creating a facility that enriches the lives of patients, families, and health care providers.
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Heart disease is the No. 1 killer among women in the United States. Differences in the clinical features of coronary heart disease among men and women have been reported, along with various approaches to the diagnostic workup and... more
Heart disease is the No. 1 killer among women in the United States. Differences in the clinical features of coronary heart disease among men and women have been reported, along with various approaches to the diagnostic workup and therapeutic interventions. To explore the relationship between descriptors of signs and symptoms of coronary heart disease and follow-up care and to investigate any differences between male and female patients. Structured interviews with patients and chart audits were used to assess initial signs and symptoms, associated cardiac-related signs and symptoms, and the diagnostic tests and interventions used for treatment. The sample consisted of 98 patients (51 women and 47 men) who were admitted with a medical diagnosis of myocardial infarction. Chest pain was the most common sign or symptom reported by both men and women. The 4 most common associated signs and symptoms were identical in men and women: fatigue, rest pain, shortness of breath, and weakness. However, significantly more women than men reported loss of appetite, paroxysmal nocturnal dyspnea, and back pain. Women were also less likely than men to have angiography and to receive i.v. nitroglycerin, heparin, and thrombolytic agents as part of acute management of myocardial infarction. Chest pain remains the initial symptom of acute myocardial infarction in both men and women. However, women may experience some different associated signs and symptoms than do men. Despite these similarities, men still are more likely than women to have angiography and to receive a number of therapies.
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Collaborative care, a multidisciplinary process to standardize and streamline care for selected case types, has gained momentum as a care delivery system in health care settings. The major goals of these programs are to improve the... more
Collaborative care, a multidisciplinary process to standardize and streamline care for selected case types, has gained momentum as a care delivery system in health care settings. The major goals of these programs are to improve the quality and continuity of care, while decreasing length of stay and cost. This article will describe key components, issues and challenges of developing, implementing and evaluating a collaborative care program for cardiovascular patients. The initial clinical path focused on bypass surgery, incorporating many of the aggressive bypass surgery recovery guidelines, such as short-acting anesthesia, same-day extubation and decreased laboratory blood analyses and test utilization. Issues that arose focused on patient selection, documentation, determining appropriateness for discontinuing paths and patient/family education. In regard to clinical outcomes, no significant differences were found in mortality or complication rates, such as postoperative bleeding, dysrhythmias and infection rates, between the clinical path group and a comparable group of non-path patients. Both intensive care unit (ICU) and overall hospital length of stay were concomitantly reduced. Other examples of program evaluation are also described, such as variation and patient follow-up data, to highlight quality improvement initiatives that further improve quality of care and reduce length of stay for this patient population.
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Interdisciplinary rounds are a new care coordination strategy in several healthcare settings. This article describes the process used by clinical nurse specialists in one institution to broaden existing discharge planning rounds to... more
Interdisciplinary rounds are a new care coordination strategy in several healthcare settings. This article describes the process used by clinical nurse specialists in one institution to broaden existing discharge planning rounds to interdisciplinary rounds. In addition, a survey queried advanced practice nurse subscribers to two listserves, the ANPACC and CNS-L, to determine how other institutions conducted interdisciplinary rounds, including structure, membership, and leadership. As a result of the changed focus in rounds, the target institution noted greater participation by all disciplines in achieving patient and family outcomes, increased early recognition of patients at risk, and improved communication among members of the healthcare team. These findings were supported by participants in the Internet survey. It was determined that interdisciplinary rounds are a valuable mechanism for improved patient outcomes and increased staff professionalism.