Patient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research.

ClinicalTrials.gov; No.: NCT01057238 ; URL: www.clinicaltrials.gov.

Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing workflow partially mediated the relationships between the intensive care unit environment and nurses' attitudes and between patient acuity and nurses' attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit.Keywords critical care; family caregivers; family-centered nursing; family engagement An increasing number of Americans require treatment in the intensive care unit (ICU), and a proportional increase in family caregivers will assume caregiving responsibilities that can have persistent negative effects on their health and overall quality of life. [1][2][3][4][5][6] The conventional ICU care paradigm has primarily targeted the informational needs of family Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH (bdh66@case.edu). HHS Public AccessAuthor manuscript AACN Adv Crit Care. Author manuscript; available in PMC 2017 September 07. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript caregivers of the critically ill, but has not addressed how to actively engage caregivers in other aspects of the ICU experience such as symptom assessment and the direct provision of care. [7][8][9][10] Although critical care research, policy, and practice guidelines 9,10 increasingly recognize family caregivers as part of a larger patient-provider interaction during critical illness, the literature on family caregiver engagement in this context mainly focuses on passive forms of involvement such as family presence, communication, and decisionmaking. Few studies address family caregivers' active contributions to patient care. 7,8,[11][12][13][14][15][16][17][18] Patient and family engagement are defined as active partnerships among health care providers, patients, and families. 7 Identifying effective ways to implement patient and family engagement is paramount to improving the patient and family experience as well as improving safety, quality, and delivery of care. [7][8][9] In the ICU, critical care nurses are the frontline providers of life-sustaining care and key staff members in promoting patient and family engagement. However, the literature provides evidence that critical care nurses express resistance to involving family caregivers because of misconception...

Prolonged stress is a potentially harmful and often undetected risk factor for chronic illness in older adults. Cortisol, one indicator of the body's hormonal responses to stress, is regulated by the hypothalamic-pituitary-adrenal (HPA) axis and is commonly measured in saliva, urine, or blood samples. Cortisol possesses a diurnal pattern and thus collection timing is critical. Hair cortisol is a proxy measure to the total retrospective activity of the HPA axis over the preceding months, much like hemoglobin A1c is a proxy measure of glucose control over the past 3 months. The aim of this review is to examine a novel biomarker, hair cortisol, as a practical measure of long-term retrospective cortisol activity associated with chronic stress in older adults. Hair cortisol analysis advances the science of aging by better characterizing chronic stress as a risk factor for chronic illness progression and as a biomarker of the effectiveness of stress reduction interventions.

The Revised Attribution Questionnaire (r-AQ) measures mental illness stigma. This study’s purpose is to evaluate the factor structure of the (r-AQ) and examine the validity of the factor structure in adolescents. A convenience sample (n=210) of adolescents completed the r-AQ and these data were used in exploratory (EFA) and confirmatory factor analyses (CFA). The EFA established a five item single factor structure, which we called the modified r-AQ and captures the negative emotional reactions to people with mental illness, a domain of mental illness stigma. The CFA established the validity of the factor structure (χ2=2.4, df=4, p=.659, TLI=1.042, CFI=1.00, RMSEA=.000). Internal consistency reliability for the scale was acceptable (α= .70). The modified r-AQ is a reliable and valid measure of the emotional reaction to people with mental illness.

The purpose of this study was to evaluate perioperative medication-related incidents (medication errors (MEs) and/or adverse medication events (AMEs)) identified by 2 different reporting methods (self-report and direct observation), and to compare the types and severity of incidents identified by each method. We compared perioperative medication-related incidents identified by direct observation in Nanji et al's 2016 study [1] to those identified by self-report via a facilitated incident reporting system at the same 1046bed tertiary care academic medical center during the same 8-month period. Incidents, including MEs and AMEs were classified by type and severity. In 277 operations involving 3671 medication administrations, 193 MEs and/or AMEs were observed (5.3% incident rate). While none of the observed incidents were self-reported, 10 separate medication-related incidents were self-reported from different (unobserved) operations that occurred during the same time period, which involved a total of 21,576 operations and approximately 280,488 medication administrations (0.004% self-reported incident rate). The distribution of incidents (ME, AME, or both) did not differ by direct observation versus self-report methodology. The types of MEs identified by direct observation differed from those identified by self-report (P = .005). Specifically, the most frequent types of MEs identified by direct observation were labeling errors (N = 37; 24.2%), wrong dose errors (N = 35; 22.9%) and errors of omission (N = 27; 17.6%). The most frequent types of MEs identified by self-report were wrong dose (N = 5; 50%) and wrong medication (N = 4; 40%). The severity of incidents identified by direct observation and self-report differed, with self-reported incidents having a higher average severity (P < .001). The procedure types associated with medication-related incidents did not differ by direct observation versus self-report methodology. Direct observation captured many more perioperative medication-related incidents than self-report. The ME types identified and their severity differed between the 2 methods, with a higher average incident severity in the self-reported data.

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