Daily Written Care Summaries for Families of Critically Ill Patients: A Randomized Controlled Trial

Greenberg, Jared A.; Basapur, Santosh; Quinn, Thomas V.; Bulger, Jeffrey L.; Schwartz, Nathaniel H.; Oh, Soo Kyung; Ritz, Ethan M.; Glover, Crystal M.; Shah, Raj C. 

Critical Care Medicine: May 23, 2022 - Volume - Issue - 10.1097

 

Objectives: 

To determine the effect of daily written updates on the satisfaction and psychologic symptoms of families of ICU patients.

Design: 

Randomized controlled trial.

Setting: 

Single, urban academic medical center.

Subjects: 

Surrogates of nondecisional, critically ill adults with high risk of mortality (n = 252) enrolled from June 2019 to January 2021.

Interventions: 

Usual communication with the medical team with or without written communication detailing the suspected cause and management approach of each ICU problem, updated each day.

Measurements and Main Results: 

Participants completed surveys at three time points during the ICU stay: enrollment (n = 252), 1 week (n = 229), and 2 weeks (n = 109) after enrollment. Satisfaction with care was measured using the Critical Care Family Needs Inventory (CCFNI). The presence of anxiety, depression, and acute stress were assessed using the Hospital Anxiety and Depression Scale (HADS) and Impact of Events Scale Revised (IES-R). CCFNI, HADS, and IES-R scores were similar among participants assigned to the intervention group and control group upon enrollment and during the first week after enrollment (p > 0.05). From enrollment to the second week after enrollment, there was an improvement in CCFNI and HADS scores among participants assigned to the intervention group versus the control group. At week 2, CCFNI scores were significantly lower among participants in the intervention group versus the control group, indicating greater satisfaction with care: 15.1 (95% CI, 14.2–16.0) versus 16.4, (95% CI, 15.5–17.3); p = 0.04. In addition, 2 weeks after enrollment, the odds of symptoms of anxiety, depression, and acute stress among participants assigned to the intervention versus control group were 0.16 (95% CI, 0.03–0.82; p = 0.03); 0.15 (95% CI, 0.01–1.87; p = 0.14); and 0.27 (95% CI, 0.06–1.27; p = 0.10), respectively.

Conclusions: 

Written communication improved satisfaction and the emotional well-being of families of critically ill patients, supporting its use as a supplement to traditional communication approaches.

 

Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs*

Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs*

by Kleinpell, Ruth; Zimmerman, Jerry; Vermoch, Kathleen L.; Harmon, Lori A.; Vondracek, Hugh; Hamilton, Rebekah; Hanson, Bruce; Hwang, David Y.

Critical Care Medicine: December 2019 - Volume 47 - Issue 12 - p 1692-1698

Objectives: As part of an improvement program targeting ICU, a national collaborative was launched to help hospitals implement patient- and family-centered care engagement initiatives.

Design: Ten-month quality improvement collaborative.

Setting: Guided by a national patient and family advisory group, participating teams implemented an individual project including open visitation; integrating families on rounds; establishing a patient and family advisory committee; using patient and family diaries, among others.

Subjects: Sixty-three adult and PICU teams from both academic and community hospitals in 34 states participated. Interventions: Monthly team calls, quarterly webinars, newsletters, an online eCommunity, and team reporting assignments were used to facilitate project implementation.

Measurements and Main Results: The Family Satisfaction with Care in the ICU 24 was used to assess family satisfaction. Clinician perceptions were assessed with the Institute for Patient- and Family-Centered Care Self-Assessment Inventory. Thematic analysis was used to explore narrative data captured from team reports of project barriers, facilitators, and the experience of participating in the collaborative. A total of 2,530 family member and 3,999 clinician surveys were completed. Postimplementation, family members reported statistically significant increases in overall family satisfaction, satisfaction with decision-making, and satisfaction with quality of care (Family Satisfaction with Care in the ICU mean score change range 0.83–1.24; p ≤ 0.027). Clinicians reported that opportunities for families to participate as members of the care team increased. Major barriers included lack of buy-in and ability to promote change in the clinical setting, managing the workload of implementation, and funding to support initiatives.

Conclusions: A national collaborative format was useful to assist ICU teams to implement patient- and family-engagement initiatives. Enlisting stakeholder support, engaging unit-based champions, and highlighting benefits of family engagement can help ICU teams to promote family member involvement and engagement.

The health promoting conversations intervention for families with a critically ill relative: A pilot study

The health promoting conversations intervention for families with a critically ill relative: A pilot study

 by S. Ågren, A. Eriksson, M. Fredrikson, G. Hollman-Frisman, L. Orwelius  

 Intensive and Critical Care Nursing – in press

Abstract

Background

After intensive care unit treatment, patients often have prolonged impairments that affect their physical, cognitive and mental health. Family members can face overwhelming and emotionally challenging situations and their concerns and needs must be addressed.

Objective

We investigated the outcomes of pilot randomised control trial, a nurse-led family intervention, Health Promoting Conversations, which focused on family functioning and wellbeing in families with a critically ill member.

Study design

This randomised controlled pilot study used a pre-test, post-test design with intervention and control groups to investigate the outcomes of the nurse-led intervention in 17 families.

Outcome measures

The Health Promoting Conversations intervention was evaluated using validated instruments that measure family functioning and family wellbeing: the General Functioning sub-scale from the McMaster Family Assessment Device; the Family Sense of Coherence, the Herth Hope Index, and the Medical Outcome Short-Form Health Survey. Descriptive and analytical statistical methods were used to analyse the data.

Results

After 12 months, the intervention group reported better family functioning than the control group. The intervention group also had better social functioning and mental health after 12 months.

Conclusion

This intervention may improve family wellbeing by improving family function, reducing stress, and promoting better mental health.

ICU family communication and health care professionals

ICU family communication and health care professionals: A qualitative analysis of perspectives. Intensive and Critical Care Nursing, May 2015 [in press]

Schubart, J.R. et al.

http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00019-1/abstract?rss=yes

Although ineffective communication is known to influence patient and family satisfaction with care in intensive care unit [ICU] settings, there has been little systematic analysis of the features of the perceived problem from a communication theory perspective. This study was undertaken to understand perceptions of miscommunication and the circumstances in which they present.

Translating and Implementing Evidence-Based Care in the ICU: It's Time to Value Family Communication.

Chest. 2008 Oct;134(4):676-8.
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