scholarly journals A national survey exploring views and experience of health professionals about transferring patients from critical care home to die

2015 ◽  
Vol 29 (4) ◽  
pp. 363-370 ◽  
Author(s):  
Anne-Sophie E. Darlington ◽  
Tracy Long-Sutehall ◽  
Alison Richardson ◽  
Maureen A. Coombs
Keyword(s):  
Critical Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Care Home ◽  
Professional Role ◽  
National Study ◽  
Web Based ◽  
Critical Care Units ◽  
The United Kingdom ◽  
Doctors And Nurses

Background: Transferring critically ill patients home to die is poorly explored in the literature to date. This practice is rare, and there is a need to understand health care professionals’ (HCP) experience and views. Objectives: To examine (1) HCPs’ experience of transferring patients home to die from critical care, (2) HCPs’ views about transfer and (3) characteristics of patients, HCPs would hypothetically consider transferring home to die. Design: A national study developing a web-based survey, which was sent to the lead doctors and nurses in critical care units. Setting/participants: Lead doctors and senior nurses (756 individuals) working in 409 critical care units across the United Kingdom were invited to participate in the survey. Results: In total, 180 (23.8%) completed surveys were received. A total of 65 (36.1%) respondents had been actively involved in transferring patients home to die and 28 (15.5%) had been involved in discussions that did not lead to transfer. Respondents were supportive of the idea of transfer home to die (88.8%). Patients identified by respondents as unsuitable for transfer included unstable patients (61.8%), intubated and ventilated patients (68.5%) and patients receiving inotropes (65.7%). There were statistically significant differences in views between those with and without experience and between doctors and nurses. Nurses and those with experience tended to have more positive views. Conclusion: While transferring patients home to die is supported in critical care, its frequency in practice remains low. Patient stability and level of intervention are important factors in decision-making in this area. Views held about this practice are influenced by previous experience and the professional role held.

scholarly journals Doctors’ and nurses’ views and experience of transferring patients from critical care home to die: A qualitative exploratory study

2014 ◽  
Vol 29 (4) ◽  
pp. 354-362 ◽  
Author(s):  
Maureen Coombs ◽  
Tracy Long-Sutehall ◽  
Anne-Sophie Darlington ◽  
Alison Richardson
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
End Of Life ◽  
Health Care Professionals ◽  
Care Home ◽  
Rare Event ◽  
Community Services ◽  
Critical Care Units ◽  
The United Kingdom ◽  
Doctors And Nurses

Background: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. Aim: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. Design: Exploratory two-stage qualitative study Setting/participants: Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. Findings: The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. Conclusion: There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.

scholarly journals Minimum standards of clinical practice for physiotherapists working in critical care settings in the United Kingdom: A modified Delphi technique

2018 ◽  
Vol 20 (2) ◽  
pp. 118-131 ◽  
Author(s):  
Paul Twose ◽  
Una Jones ◽  
Gareth Cornell
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
Clinical Practice ◽  
Delphi Technique ◽  
Minimum Standard ◽  
Knowledge And Skills ◽  
Critical Care Units ◽  
Modified Delphi ◽  
The United Kingdom ◽  
Modified Delphi Technique

Introduction Across the United Kingdom, physiotherapy for critical care patients is provided 24 h a day, 7 days per week. There is a national drive to standardise the knowledge and skills of physiotherapists which will support training and reduce variability in clinical practice. Methods A modified Delphi technique using a questionnaire was used. The questionnaire, originally containing 214 items, was completed over three rounds. Items with no consensus were included in later rounds along with any additional items suggested. Results In all, 114 physiotherapists from across the United Kingdom participated in the first round, with 102 and 92 completing rounds 2 and 3, respectively. In total, 224 items were included: 107 were deemed essential as a minimum standard of clinical practice; 83 were not essential and consensus was not reached for 34 items. Analysis/Conclusion This study identified 107 items of knowledge and skills that are essential as a minimum standard for clinical practice by physiotherapists working in United Kingdom critical care units.

scholarly journals Death Notification in Italian Critical Care Unites and Emergency Services. A Qualitative Study with Physicians, Nurses and Relatives

2021 ◽  
Vol 18 (24) ◽  
pp. 13338
Author(s):  
Ines Testoni ◽  
Erika Iacona ◽  
Lorenza Palazzo ◽  
Beatrice Barzizza ◽  
Beatrice Baldrati ◽  
...  
Keyword(s):  
Critical Care ◽  
Qualitative Study ◽  
Protective Factors ◽  
Health Care Professionals ◽  
Emergency Services ◽  
Continuing Bonds ◽  
Critical Care Units ◽  
Death Notification ◽  
The Impact ◽  
Relational Difficulties

This qualitative study was conducted in critical care units and emergency services and was aimed at considering the death notification (DN) phenomenology among physicians (notifiers), patient relatives (receivers) and those who work between them (nurses). Through the qualitative method, a systemic perspective was adopted to recognise three different categories of representation: 23 clinicians, 13 nurses and 11 family members of COVID-19 victims were interviewed, totalling 47 people from all over Italy (25 females, mean age: 46,36; SD: 10,26). With respect to notifiers, the following themes emerged: the changes in the relational dimension, protective factors and difficulties related to DN. With respect to receivers, the hospital was perceived as a prison, bereavement between DN, lost rituals and continuing bonds. Among nurses, changes in the relational dimension, protective factors and the impact of the death. Some common issues between physicians and nurses were relational difficulties in managing distancing and empathy and the support of relatives and colleagues. The perspective of receivers showed suffering related to loss and health care professionals’ inefficacy in communication. Specifically, everyone considered DNs mismanaged because of the COVID-19 emergency. Some considerations inherent in death education for DN management among health professionals were presented.

scholarly journals Factors Associated with Perceived Stressors among Critical Care Units Adult Patients: An Exploratory Study

2021 ◽  
pp. 204-209
Author(s):  
Swapnil Rahane ◽  
Roma Patel ◽  
Devrajsingh Chouhan
Keyword(s):  
Critical Care ◽  
Health Care Professionals ◽  
Critical Care Unit ◽  
Sampling Technique ◽  
Adult Patients ◽  
Exploratory Research ◽  
Related Complication ◽  
Early Recovery ◽  
Financial Problems ◽  
Critical Care Units

The critical care unit environment has been observed as a leading stressor not only amongst the health care professionals but in patients also. Unfamiliar surroundings, dependency on others, financial problems, etc. are among factors that are responsible for the development of stress in the patients admitted to the critical care units. Stress and its factors are also responsible for the patient's deliberate recovery and depraved prognosis. In this study, we explored the association between selective factors and perceived stressors among adult patients admitted to critical care units. A quantitative, exploratory research design study was conducted, to identify the association between the perceived stressors and selected factors of adult patients admitted in Critical Care Units of the selected multispecialty hospitals at Vadodara. A total of sixty patients admitted to the critical care departments were selected through the convenience sampling technique. A demographic variables datasheet and hospitals stress rating interview scale was used after the expert’s content validation to collect the data. Analysis and interpretation of data were done by using descriptive and inferential statistics. Results: Study findings revealed that all the patients, who were interviewed through the hospital stress interview scale, expressed the perception of stressors as indicated by the total perceived stressors score of above (1%). The study also revealed that separation from family members or spouses and financial problems are the highly rated perceived stressors among the patients admitted to the critical care unit. Patients also reported the least perceived stressful area was the problem with medication. There was a significant association between the socioeconomic status and medical-surgical diagnosis of patients with perceived stressors. Conclusion: Therefore, the findings of the study concluded that the study, patients admitted in the critical care department also suffer from stress due to some stressors, and it affects their prognosis and early recovery. Nursing professionals need to focus on the subjective characteristics of patients so that perceived stressors and early detection of the related complication can be prevented.

scholarly journals A Web-Based Alcohol Risk Communication Tool: Development and Pretesting Study (Preprint)

2018 ◽  
Author(s):  
Bridget Kool ◽  
Rosie Dobson ◽  
Sarah Sharpe ◽  
Gayl Humphrey ◽  
Robyn Whittaker ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Risk Communication ◽  
Health Professionals ◽  
Health Concern ◽  
Communication Tool ◽  
Web Based ◽  
Key Informants ◽  
Alcohol Risk ◽  
Doctors And Nurses

BACKGROUND Alcohol use is a major public health concern associated with an increased risk of morbidity and mortality. Health professionals in primary care commonly see patients with a range of alcohol-related risks and problems, providing an ideal opportunity for screening and brief intervention (BI). OBJECTIVE This study aimed to develop a prototype for a Web-based tool for use by primary care health professionals (eg, doctors and nurses) to communicate alcohol harm risk to their patients and to engage with them regarding ways this risk could be reduced. METHODS Following conceptualization and development of prototype wireframes, formative work and pretesting were undertaken. For the formative work, focus groups and key informant interviews were conducted with potential end users of the risk communication tool, including health professionals and consumers. The focus groups and interviews explored perceptions of alcohol risk communication and obtained feedback on the initial prototype. For pretesting, participants (primary care doctors and nurses) completed a Web-based survey followed by a period of pretesting before completion of a follow-up survey. The study was designed to gain feedback on the tool’s performance in real-world settings as well as its relevance, ease of use, and any suggested refinements. RESULTS In the formative work stage, 11 key informants and 7 consumers participated in either focus groups or individual interviews. Participants were very positive about the prototype and believed that it would be useful and acceptable in practice. Key informants identified that the key point of difference with the tool was that it provided <italic>all the pieces</italic> in 1 place (ie, assessment, interpretation, and resources to support change). Participants provided feedback on how the tool could be improved, and these suggestions were incorporated into the prototype where possible. In the pretesting stage, 7 people (5 doctors and 2 primary care nurses) completed the pretesting. Participants reported that the tool provided a useful framework for an intervention, that it would be acceptable to patients, that it was easy to use, that they would be likely to use it in practice, and that there were no technical issues. CONCLUSIONS The alcohol risk communication tool was found to be acceptable and has the potential to increase the confidence of health professionals in assessing risk and providing BI.

Nurse-physician collaboration in an intensive care unit

2001 ◽  
Vol 10 (5) ◽  
pp. 341-350 ◽  
Author(s):  
PA Miller
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Quality Improvement ◽  
National Study ◽  
Improvement Program ◽  
Critical Care Units ◽  
Improvement Programs ◽  
Nurses And Physicians ◽  
Collaborative Interaction

BACKGROUND: Collaborative interaction between nurses and physicians on critical care units is significantly related to mortality rates and length of stay in the units. For this reason, collaborative interaction should be an integral part of quality improvement programs. OBJECTIVES: To examine perspectives of nurses and physicians on collaborative interaction in an intensive care unit, to examine differences between groups in perceptions of collaborative interaction in the unit, and to compare this unit with units examined in a national study. METHODS: A modification of the ICU Nurse-Physician Questionnaire was used to collect data from 35 nurses and 45 physicians. Descriptive statistics and analysis of variance were used to determine group scores and to examine differences between groups. RESULTS: The level of collaborative interaction in the unit was high. However, nurses and physicians and all other staff groups examined except one had significant differences in perceptions of collaborative interaction. The high level of collaborative interaction was confirmed by a comparison of the results with the results from a national sample. CONCLUSIONS: Critical care units can use this example to incorporate an assessment of the level of collaborative interaction into their quality improvement program.

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