Overview of Family Needs after Critical Illness: From Assessment to Intervention

1991 ◽  
Vol 2 (2) ◽  
pp. 220-226 ◽  
Author(s):  
Jane Stover Leske
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Critical Care Nurses ◽  
Nursing Interventions ◽  
Family Needs ◽  
Analysis Of Results ◽  
Family Centered ◽  
Primary Family ◽  
Over Time

Results of numerous independent studies suggest that families of a critically ill hospitalized member have similar needs that they can readily identify as very important. Empirical analysis of results compiled from many studies across patient populations, settings, geographic locations, and over time indicates that families have primary needs for assurance, proximity, and information. These primary family needs provide a research-based framework to guide critical care nurses in implementing and evaluating family-centered nursing interventions

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

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.

Quality assurance and the critical care nurse

1991 ◽  
Vol 11 (9) ◽  
pp. 34-40
Author(s):  
P Brown-Stewart
Keyword(s):  
Quality Assurance ◽  
Critical Care ◽  
Critically Ill ◽  
Monitoring And Evaluation ◽  
Critical Care Nurses ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Appropriateness Of Care ◽  
External Sources ◽  
The Way

Care of the critically ill has become increasingly challenging due to demands from external sources to measure the quality and appropriateness of care provided. Quality assurance is the responsibility of every critical care nurse and requires vigilance as well as a knowledge of the principles of standards, monitoring and evaluation. Through quality assurance activities, the contribution of critical care nurses in the achievement of patient outcomes can be measured. Quality assurance challenges us to evaluate the way we practice, and assists us to continuously improve the way we provide care to critically ill patients.

scholarly journals Comparison between nurses' and families' opinion about priorities of immediate patient's family needs

2018 ◽  
Vol 9 (1) ◽  
pp. 113
Author(s):  
Intessar Mohamed Ahmad
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Time Frame ◽  
Medical Institute ◽  
Family Needs ◽  
The Family ◽  
The Mean ◽  
Individual Needs ◽  
Strongly Agree

Background and objective: Acute critical illness represents a crisis not just for the individual patient however conjointly for the members of the family. Moreover, the admission of the patient represents a sudden crisis allowing no time for its preparation. The responsibilities of critical care nurses extend beyond the patients in the intensive care unit (ICU) to incorporate the members of the family of these patients. Nurses are a primary resource for members of family of ICU patients and they are in a perfect position to assist patients’ members of the family in an applicable approach. For this reason, recognition of these needs by nursing personnel is very important for applying of holistic nursing care. The aims of this study were 1) Ranking the immediate needs of members of family of critically ill patients and nurses. 2) Comparing between nurses, and families, opinion regarding priorities of immediate patient's family needs using Critical Care Family Needs Inventory (CCFNI).Methods: This descriptive study was conducted at the general ICUs of Damanhour Medical Institute which has 15 beds, Damanhour chest hospital which has 7 beds and Itay Elbaroad General Hospital which has 11 beds. The three units have a total of 100 nurses. A questionnaire was used for data collection. It consisted of part one which comprised patient's condition whose families were studied participants, biosocial knowledge related to the members of family and part two which included CCFNI tool. The adapted CCFNI was translated into colloquial Arabic. Participant members of family were individually interviewed by the researcher. Members of family were required to answer each statement with strongly agree, agree, neutral, do not agree and strongly do not agree. The interview took approximately 45 to 60 minutes to be completed, and all interviews took place within the 72 hours' time frame of each patient's admission to the critical care unit. The nurses were approached and given the questionnaires to be filled in by themselves during handover, tea or lunch break.Results: Generally, families ranked their knowledge, proximity and comfort needs higher in importance than the nurses. Also, the knowledge and assurance needs were ranked above the needs for support, comfort, and proximity by our participating nurses and members of family. Moreover, the mean scores of knowledge, proximity, support and comfort needs for members of family were significantly higher than these for nurses. Out of 35 needs of the members of family in the CCFNI, there were no significant differences between the mean scores of the nurses and those of the members of family in 10 individual needs. Results show that the nurses were correct in 10 out of 35 members of family’ individual needs. The remaining mean scores from 25 individual needs showed significant differences between the nurses and actual family needs. Results show that did not meet all the specific family needs during the care of the critically ill patients. Results show that members of family scored significantly higher than nurses on 20 statements while, the nurses scored significantly higher than members of family on only 5 of the statements.Conclusions: Families considered that knowledge then assurance was the most important needs. While nurses considered that assurance then knowledge were the most important needs which indicate that nurses underestimated the needs of the family and family need may be inaccurately evaluated by heath care team and almost unmet. Furthermore, Members of family in this study considered the needs that bring comfort and support as less in priority needs.

Hospital Readmission and Post-Acute Care Use After Intensive Care Unit Admissions: New ICU Quality Metrics?

2020 ◽  
pp. 088506662095663
Author(s):  
Christopher F. Chesley ◽  
Michael O. Harhay ◽  
Dylan S. Small ◽  
Asaf Hanish ◽  
Hallie C. Prescott ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Acute Care ◽  
Hospital Readmission ◽  
Critical Care Unit ◽  
Readmission Rates ◽  
Critical Care Units ◽  
Icu Admission ◽  
Over Time ◽  
Post Acute Care

Objective: Care coordination is a national priority. Post-acute care use and hospital readmission appear to be common after critical illness. It is unknown whether specialty critical care units have different readmission rates and what these trends have been over time. Methods: In this retrospective cohort study, a cohort of 53,539 medical/surgical patients who were treated in a critical care unit during their index admission were compared with 209,686 patients who were not treated in a critical care unit. The primary outcome was 30-day all cause hospital readmission. Secondary outcomes included post-acute care resource use and immediate readmission, defined as within 7 days of discharge. Results: Compared to patients discharged after an index hospitalization without critical illness, surviving patients following ICU admission were not more likely to be rehospitalized within 30 days (15.8 vs. 16.1%, p = 0.08). However, they were more likely to receive post-acute care services (45.3% vs. 70.9%, p < 0.001) as well as be rehospitalized within 7 days (5.2 vs. 6.0%, p < 0.001). Post-acute care use and 30-day readmission rates varied by ICU type, the latter ranging from 11.7% after admission in a cardiothoracic critical care unit to 23.1% after admission in a medical critical care unit. 30-day readmission after ICU admission did not decline between 2010 and 2015 (p = 0.38). Readmission rates declined over time for 2 of 4 targeted conditions (heart failure and chronic obstructive pulmonary disease), but only when the hospitalization did not include ICU admission. Conclusions: Rehospitalization for survivors following ICU admission is common across all specialty critical care units. Post-acute care use is also common for this population of patients. Overall trends for readmission rates after critical illness did not change over time, and readmission reductions for targeted conditions were limited to hospitalizations that did not include an ICU admission.

Exertional Heat Stroke in Navy and Marine Personnel: A Hot Topic

2015 ◽  
Vol 35 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Carl W. Goforth ◽  
Josh B. Kazman
Keyword(s):  
Critical Care ◽  
Heat Stroke ◽  
Significant Risk ◽  
Critical Care Nurses ◽  
Body Core Temperature ◽  
Nursing Interventions ◽  
Military Operations ◽  
Exertional Heat Stroke ◽  
Military Nurses ◽  
Extrinsic Risk

Although exertional heat stroke is considered a preventable condition, this life-threatening emergency affects hundreds of military personnel annually. Because heat stroke is preventable, it is important that Navy critical care nurses rapidly recognize and treat heat stroke casualties. Combined intrinsic and extrinsic risk factors can quickly lead to heat stroke if not recognized by deployed critical care nurses and other first responders. In addition to initial critical care nursing interventions, such as establishing intravenous access, determining body core temperature, and assessing hemodynamic status, aggressive cooling measures should be initiated immediately. The most important determinant in heat stroke outcome is the amount of time that patients sustain hyperthermia. Heat stroke survival approaches 100% when evidence-based cooling guidelines are followed, but mortality from heat stroke is a significant risk when care is delayed. Navy critical care and other military nurses should be aware of targeted assessments and cooling interventions when heat stroke is suspected during military operations. (Critical Care Nurse. 2015;35[1]:52–59)

Strategies for Acute and Critical Care Nurses Implementing Complementary Therapies Requested by Patients and Their Families

2016 ◽  
Vol 36 (6) ◽  
pp. 52-58 ◽  
Author(s):  
Debra Kramlich
Keyword(s):  
Critical Care ◽  
Complementary Therapies ◽  
Care Setting ◽  
The United States ◽  
Critical Care Nurses ◽  
Critical Care Setting ◽  
Complementary And Alternative Therapies ◽  
Centered Care ◽  
Family Centered ◽  
Complementary And Alternative

As consumer use of complementary and alternative medicine or modalities continues to increase in the United States, requests for these therapies in the acute and critical care setting will probably continue to expand in scope and frequency. Incorporation of complementary therapies in the plan of care is consistent with principles of patient- and family-centered care and collaborative decision-making and may provide a measure of relief for the distress of admission to an acute or critical care setting. An earlier article provided an overview of complementary and alternative therapies that nurses may encounter in their practices, with specific attention to implications for acute and critical care nurses. This article provides key information on the legal, ethical, safety, quality, and financial challenges that acute and critical care nurses should consider when implementing patient and family requests for complementary therapies.

scholarly journals Whole genome sequencing identifies multiple loci for critical illness caused by COVID-19

2021 ◽  
Author(s):  
Athanasios Kousathanas ◽  
Erola Pairo-Castineira ◽  
Konrad Rawlik ◽  
Alex Stuckey ◽  
Christopher A Odhams ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Whole Genome Sequencing ◽  
Critically Ill ◽  
Genome Sequencing ◽  
Blood Type ◽  
Host Immune System ◽  
Whole Genome ◽  
Mucin Expression ◽  
Population Controls

Critical illness in COVID-19 is caused by inflammatory lung injury, mediated by the host immune system. We and others have shown that host genetic variation influences the development of illness requiring critical care or hospitalisation following SARS-Co-V2 infection. The GenOMICC (Genetics of Mortality in Critical Care) study is designed to compare genetic variants in critically-ill cases with population controls in order to find underlying disease mechanisms. Here, we use whole genome sequencing and statistical fine mapping in 7,491 critically-ill cases compared with 48,400 population controls to discover and replicate 22 independent variants that significantly predispose to life-threatening COVID-19. We identified 15 new independent associations with severe COVID-19, including variants within genes involved in interferon signalling (IL10RB, PLSCR1), leucocyte differentiation (BCL11A), and blood type secretor status (FUT2). Using transcriptome-wide association and colocalisation to infer the effect of gene expression on disease severity, we find evidence implicating expression of multiple genes, including reduced expression of a membrane flippase (ATP11A), and increased mucin expression (MUC1), in severe disease. We show that comparison between critically-ill cases and population controls is highly efficient for genetic association analysis and enables detection of therapeutically-relevant mechanisms of disease. Therapeutic predictions arising from these findings require testing in clinical trials.

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