Barriers to Addressing the Spiritual and Religious Needs of Patients and Families in the Intensive Care Unit: A Qualitative Study of Critical Care Physicians

Objectives: Though critical care physicians feel responsible to address spiritual and religious needs with patients and families, and feel comfortable in doing so, they rarely address these needs in practice. We seek to explore this discrepancy through a qualitative interview process among physicians in the intensive care unit (ICU). Methods: A qualitative research design was constructed using semi-structured interviews among 11 volunteer critical care physicians at a single institution in the Midwest. The physicians discussed barriers to addressing spiritual and religious needs in the ICU. A code book of themes was created and developed through a regular and iterative process involving 4 investigators. Data saturation was reached as no new themes emerged. Results: Physicians reported feeling uncomfortable in addressing the spiritual needs of patients with different religious views. Physicians reported time limitations, and prioritized biomedical needs over spiritual needs. Many physicians delegate these conversations to more experienced spiritual care providers. Physicians cited uncertainty into how to access spiritual care services when they were desired. Additionally, physicians reported a lack of reminders to meet these needs, mentioning frequently the ICU bundle as one example. Conclusions: Barriers were identified among critical care physicians as to why spiritual and religious needs are rarely addressed. This may help inform institutions on how to better meet these needs in practice.

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Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data

American Journal of Critical Care ◽

10.4037/ajcc2020661 ◽

2020 ◽

Vol 29 (4) ◽

pp. e81-e91

Author(s):

Renea L. Beckstrand ◽

Jasmine B. Jenkins ◽

Karlen E. Luthy ◽

Janelle L. B. Macintosh

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

End Of Life ◽

Health Care Providers ◽

End Of Life Care ◽

Critical Care Nurses ◽

Life Care ◽

Care Providers ◽

Over Time

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. Conclusions The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.

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Spiritual care for the critically ill

American Journal of Critical Care ◽

10.4037/ajcc1995.4.1.77 ◽

1995 ◽

Vol 4 (1) ◽

pp. 77-81 ◽

Cited By ~ 13

Author(s):

C Clark ◽

T Heidenreich

Keyword(s):

Critical Care ◽

Intensive Care ◽

Spiritual Care ◽

Well Being ◽

Nursing Interventions ◽

Negative Feeling ◽

Technical Competence ◽

Care Providers ◽

Spiritual Assessment ◽

Spiritual Well Being

BACKGROUND: Spiritual well-being is the center of a healthy lifestyle and enables holistic integration of one's inner resources. However, the professional education process does not adequately provide socialization of nurses in the provision of spiritual care. Few studies exist that adequately address the spiritual aspect of nursing care. PURPOSE: To identify factors that contribute to providing spiritual care for patients in intensive care units. METHODS: A descriptive research design was used for this replication study conducted on a convenience sample of 63 patients in the critical care unit of a large midwestern military hospital. A trained interviewer asked each participant three open-ended questions regarding events that had created hope or meaning, created negative feeling, and could have contributed to hope or meaning. The interview took place 1 to 2 days after discharge from the intensive care unit. Predominant patterns were determined by content analysis. RESULTS: Three themes were identified as integral to the spiritual well-being of critical care patients: care providers, family/friends, and religion/faith. Nursing interventions identified for the three themes include establishing trusting relationships, providing in-depth spiritual assessment, conveying technical competence, and acting as facilitator among family, clergy, and other providers. CONCLUSIONS: We conclude that the key nursing interventions derived from this study include listening to patients' concerns and maintaining and conveying technical competence.

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A study of medication errors during the prescription stage in the pediatric critical care services of a secondary-tertiary level public hospital

BMC Pediatrics ◽

10.1186/s12887-020-02442-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lorena Michele Brennan-Bourdon ◽

Alan O. Vázquez-Alvarez ◽

Jahaira Gallegos-Llamas ◽

Manuel Koninckx-Cañada ◽

José Luis Marco-Garbayo ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Medication Errors ◽

Public Hospital ◽

Care Practice ◽

Tertiary Level ◽

Skin Reactions ◽

Pediatric Critical Care ◽

Care Services

Abstract Background Medication Errors (MEs) are considered the most common type of error in pediatric critical care services. Moreover, the ME rate in pediatric patients is up to three times higher than the rate for adults. Nevertheless, information in pediatric population is still limited, particularly in emergency/critical care practice. The purpose of this study was to describe and analyze MEs in the pediatric critical care services during the prescription stage in a Mexican secondary-tertiary level public hospital. Methods A cross-sectional study to detect MEs was performed in all pediatric critical care services [pediatric emergency care (PEC), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and neonatal intermediate care unit (NIMCU)] of a public teaching hospital. A pharmacist identified MEs by direct observation as the error detection method and MEs were classified according to the updated classification for medication errors by the Ruíz-Jarabo 2000 working group. Thereafter, these were subclassified in clinically relevant MEs. Results In 2347 prescriptions from 301 patients from all critical care services, a total of 1252 potential MEs (72%) were identified, and of these 379 were considered as clinically relevant due to their potential harm. The area with the highest number of MEs was PICU (n = 867). The ME rate was > 50% in all pediatric critical care services and PICU had the highest ME/patient index (13.1). The most frequent MEs were use of abbreviations (50.9%) and wrong speed rate of administration (11.4%), and only 11.7% of the total drugs were considered as ideal medication orders. Conclusion Clinically relevant medication errors can range from mild skin reactions to severe conditions that place the patient’s life at risk. The role of pharmacists through the detection and timely intervention during the prescription and other stages of the medication use process can improve drug safety in pediatric critical care services.

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A California Hospital’s Response to COVID-19: From a Ripple to a Tsunami Warning

Critical Care Nurse ◽

10.4037/ccn2020799 ◽

2020 ◽

Vol 40 (6) ◽

pp. e1-e16

Author(s):

Mary Kay Bader ◽

Annabelle Braun ◽

Cherie Fox ◽

Lauren Dwinell ◽

Jennifer Cord ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Intensive Care Units ◽

Task Force ◽

The United States ◽

Tsunami Warning ◽

Care Services ◽

Evidence Review ◽

Excellent Care

Background The outbreak of coronavirus disease 2019 (COVID-19) rippled across the world from Wuhan, China, to the shores of the United States within a few months. Hospitals and intensive care units were suddenly faced with a “tsunami” warning requiring instantaneous implementation and escalation of disaster plans. Evidence Review An evidence-based question was developed and an extensive review of the literature was completed, resulting in a structured plan for the intensive care units to manage a surge of patients critically ill with COVID-19 in March 2020. Twenty-five sources of evidence focusing on pandemic intensive care unit and COVID-19 management laid the foundation for the team to navigate the crisis. Implementation The Critical Care Services task force adopted recommendations from the CHEST consensus statement on surge capacity principles and other sources, which served as the framework for the organized response. The 4 S’s became the focus: space, staff, supplies, and systems. Development of algorithms, workflows, and new processes related to treating patients, staffing shortages, and limited supplies. New intensive care unit staffing solutions were adopted. Evaluation Using a framework based on the literature reviewed, the Critical Care Services task force controlled the surge of patients with COVID-19 in March through May 2020. Patients received excellent care, and the mortality rate was 0.008%. The intensive care unit team had the needed respiratory and general supplies but had to continually adapt to shortages of personal protective equipment, cleaning products, and some medications. Sustainability The intensive care unit pandemic response plan has been established and the team is prepared for the next wave of COVID-19.

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Lessons for intensive care units in COVID-19 pandemic-moving towards sustainability

Discussion of Clinical Cases ◽

10.5430/dcc.v7n3p1 ◽

2020 ◽

Vol 7 (3) ◽

pp. 1

Author(s):

Prashant Nasa ◽

Ruchi Nasa ◽

Aanchal Singh

Keyword(s):

Critical Care ◽

Supply Chain ◽

Intensive Care ◽

Intensive Care Units ◽

Standard Of Care ◽

Infrastructure Development ◽

Care Providers ◽

Care Services ◽

Second Wave ◽

And Training

The Coronavirus disease-2019 (COVID-19) pandemic has inundated critical care services globally. The intensive care units (ICUs) and critical care providers have been forefront of this pandemic, evolving continuously from experiences and emerging evidence. In this review, we discuss the key lessons from the ongoing wave of COVID-19 pandemic and preparations for a future surge or second wave. The model of sustainable critical care services should be based on 1) infrastructure development, 2) preparation and training of manpower, 3) implementing standard of care and infection control, 4) sustained supply-chain and finally, and 5) surge planning.

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Religion and Spirituality in the Intensive Care Unit

10.1093/med/9780190272432.003.0011 ◽

2017 ◽

Author(s):

Alexandra Cist ◽

Philip Choi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Therapeutic Alliance ◽

Spiritual Care ◽

Spiritual Needs ◽

Medical Team ◽

Religion And Spirituality ◽

High Quality ◽

Acute Nature ◽

Prognostic Uncertainty

The Intensive Care Unit is an area of the hospital that can elicit high levels of emotional and spiritual distress due to high mortality and prognostic uncertainty. Religion and spirituality are often manifest through prayer, rituals, and ceremonies, which can unite the patient and family with the care team. However, miracle language and other religious or spiritual topics that misalign with the expectations of the medical team can also lead to discord. The acute nature of ICU care poses challenges in creating a therapeutic alliance necessary to effectively address the religious and spiritual needs of patients and families. In this chapter, we provide a practical approach to provide high quality spiritual care in the ICU.

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Religion and Spiritual Care in Pediatric Intensive Care Unit: Parental Attitudes Regarding Physician Spiritual and Religious Inquiry

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909116682016 ◽

2016 ◽

Vol 35 (1) ◽

pp. 28-33 ◽

Cited By ~ 8

Author(s):

Tsovinar Arutyunyan ◽

Folafoluwa Odetola ◽

Ryan Swieringa ◽

Matthew Niedner

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Spiritual Care ◽

Religious Beliefs ◽

Parental Attitudes ◽

Academic Medical Center ◽

Pediatric Intensive Care ◽

Care Providers ◽

Seriously Ill

Objective: Parents of seriously ill children require attention to their spiritual needs, especially during end-of-life care. The objective of this study was to characterize parental attitudes regarding physician inquiry into their belief system. Materials and Main Results: A total of 162 surveys from parents of children hospitalized for >48 hours in pediatric intensive care unit in a tertiary academic medical center were analyzed. Forty-nine percent of all respondents and 62% of those who identified themselves as moderate to very spiritual or religious stated that their beliefs influenced the decisions they made about their child’s medical care. Although 34% of all respondents would like their physician to ask about their spiritual or religious beliefs, 48% would desire such enquiry if their child was seriously ill. Those who identified themselves as moderate to very spiritual or religious were most likely to welcome the discussion ( P < .001). Two-thirds of the respondents would feel comforted to know that their child’s physician prayed for their child. One-third of all respondents would feel very comfortable discussing their beliefs with a physician, whereas 62% would feel very comfortable having such discussions with a chaplain. Conclusion: The study findings suggest parental ambivalence when it comes to discussing their spiritual or religious beliefs with their child’s physicians. Given that improved understanding of parental spiritual and religious beliefs may be important in the decision-making process, incorporation of the expertise of professional spiritual care providers may provide the optimal context for enhanced parent–physician collaboration in the care of the critically ill child.

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Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

American Journal of Critical Care ◽

10.4037/ajcc2009131 ◽

2010 ◽

Vol 19 (3) ◽

pp. 272-276 ◽

Cited By ~ 21

Author(s):

Mohamad F. El-Khatib ◽

Salah Zeineldine ◽

Chakib Ayoub ◽

Ahmad Husari ◽

Pierre K. Bou-Khalil

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Evidence Based ◽

Ventilator Associated Pneumonia ◽

Care Providers ◽

Care Experience ◽

Respiratory Therapists ◽

Evidence Based Guidelines

Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended.Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia.Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia.Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience.Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia.

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Antibiotic Skin Testing in the Intensive Care Unit: A Systematic Review

Critical Care Nurse ◽

10.4037/ccn2019207 ◽

2019 ◽

Vol 39 (6) ◽

pp. e1-e9

Author(s):

Homood A. Alharbi

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Skin Test ◽

Immunoglobulin E ◽

Skin Testing ◽

Oral Challenge ◽

Acute Tolerance ◽

Care Providers

Background Recent research has shown that a large majority of patients with a history of penicillin allergy are acutely tolerant of penicillins and that there is no clinically significant immunologic cross-reactivity between penicillins and cephalosporins or other β-lactams. The standard test to confirm acute tolerance is challenge with a therapeutic dose. Skin testing is useful only when the culprit antibiotic can haptenate serum proteins and induce an immunoglobulin E–mediated reaction and the clinical history demonstrates such high risk that a direct oral challenge may result in anaphylaxis. Objective To review and evaluate the current practice of skin testing for antibiotics (other than penicillin) in critically ill patients by means of a systematic literature review. Methods This systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Several electronic databases were searched using the following terms: antibiotics, skin test (tests, testing), intensive care, intensive care unit, ICU, critical care, critical care unit. Results Twenty-three articles were identified for inclusion in this review. The results indicate a lack of standardized skin testing for all antibiotics in critical care settings. Oral challenge with nonirritating concentrations of antibiotics can be helpful in determining allergy to these drugs. Conclusions Critical care providers should evaluate antibiotic allergy using nonirritating concentrations before administering antibiotics to patients. Introduction of a standardized skin test for all antibiotics in intensive care unit patients to help select the most appropriate antibiotic treatment regimen might help save lives and reduce costs.

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Prerequisites for provision of spiritual care in the neonatal intensive care unit in Iran: a qualitative study

10.21203/rs.3.rs-58551/v1 ◽

2020 ◽

Author(s):

Haideh Heidari ◽

Nasrin Mehrnoush ◽

Mansoureh Karimollahi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Health Care Providers ◽

Spiritual Care ◽

Neonatal Intensive Care ◽

Nurse Managers ◽

Qualitative Content Analysis ◽

Care Providers ◽

Families With Children

Abstract Background: Spiritual care in line with the holistic and comprehensive care is the important need for families with children who are hospitalized in an intensive care unit. Objectives: This study aimed to explore perceptions of health care providers' regarding the spiritual care of parents with a newborn in the neonatal intensive care unit in Iran.Materials/Patients and Methods: This study was conducted using qualitative content analysis which includes open coding, creating classification, and abstraction. Eight nurses and one doctor were chosen to be interviewed by a purposeful sampling method.Results: Based on data analysis three categories of nurses' support need for spiritual care and the necessity of changes in structural conditions were identified.Conclusions: Hospital administrators must adopt measures to change the neonatal intensive care unit circumstances. Also, it is mandated that nurse managers plan training about the importance of providing spiritual care to patients and families.

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