An integrative review of supports, facilitators and barriers to patient‐centred nursing in the intensive care unit

Jakimowicz, Samantha; Perry, Lin; Lewis, Joanne

doi:10.1111/jocn.13957

Cited by 26 publications

(26 citation statements)

References 37 publications

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“…In this study, nurses' feelings of stress related to the heavy workload in the department, contributed to feelings of job dissatisfaction because the nurses were sometimes forced to decline this kind of care when the workload was too great. Intensive care nurse job satisfaction and workforce maintenance are aspects of patient-centered nursing [10]. Thus, the healthcare service should to continue to develop a positive workplace atmosphere supported with more workforce resources.…”

Section: Discussion Of the Findingsmentioning

confidence: 99%

Intensive Care Nurses’ Experiences of Caring for Intubated Patients under Light Sedation: A Qualitative Study

Bäcklund¹,

Persson²,

Hadziabdic³

2018

OJN

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Introduction: Previous studies have shown that a light sedation level is beneficial for intubated patients in the Intensive care unit (ICU). Aim: This study aimed to describe intensive care nurses' experiences of caring for intubated patients under light sedation. Methods: This study was an explorative descriptive qualitative study. Data were collected from 12 intensive care nurses by three focus group interviews and analyzed using qualitative content analysis. Findings: Five categories emerged from the data: 1) the importance of verbal communication and the nurses' presence, 2) feelings of frustration and heavy workload, 3) assessment of patients' pain and anxiety, 4) the nurses' desire for the development of guidelines, and 5) being inspired by the care. Conclusion: The study found that intensive care nurses were positive towards light sedation care but the organization of care did not support them as the patients cared for with light sedation treatments demanded their physical presence at patients' bed site.

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Section: Discussion Of the Findingsmentioning

confidence: 99%

Intensive Care Nurses’ Experiences of Caring for Intubated Patients under Light Sedation: A Qualitative Study

Bäcklund¹,

Persson²,

Hadziabdic³

2018

OJN

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“…This environment may impact delivery of patient‐centred nursing both positively and negatively (Kelleher, ; Mohammadi, Peyrovi, & Mahmoodi, ). A dominant biomedical curative ethos and local features such as collegial support, workplace culture, communication and relationships (Jakimowicz, Perry, & Lewis, ; Jones, Winch, Strube, Mitchell, & Henderson, ) may both hinder and support maintenance of aspects of patient‐centred nursing. For example, patients in critical care units are seldom able to partner in their treatment plans and goals, especially when they experience life‐threatening illness or injury, and are unable to communicate (Jakimowicz & Perry, ).…”

Section: Introductionmentioning

confidence: 99%

“…Patient and Family‐Centred Care (PFCC) is a model developed for this very reason, an approach where the patient is viewed as a member of the family system, requiring care and partnership for all members of the group (Latour & Coombs, ). Providing the “softer skills” required to deliver compassionate, professional critical care nursing while managing a physiologically unstable patient in the confines of an equipment‐cramped bed space and supporting the family makes patient‐centred nursing in this aggressively curative environment extremely challenging (Jakimowicz et al., ; Latour & Coombs, ).…”

Section: Introductionmentioning

confidence: 99%

“…Professional standards and education levels of ICU nurses are similar internationally (AACN , Bray et al., ; Robnett, ) and a number of codes of nursing practice (ACCCN , BACCN ), hospital vision and mission statements and registered nurse job descriptions (WHO ) call for compassionate patient‐centred nursing. Critical care nurses are often challenged to deliver this under the pressure of patient flow and budgetary constraints (van Dam et al., ) in a world demanding cost‐contained but innovative and high‐quality health services (Jakimowicz et al., ).…”

Section: Introductionmentioning

confidence: 99%

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Insights on compassion and patient‐centred nursing in intensive care: A constructivist grounded theory

Jakimowicz

Perry

Lewis

2018

Journal of Clinical Nursing

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“…PCC within ICUs has not been explored to any great extent, perhaps due to the difficulties of communicating with the patients and thereby of gaining an understanding of what is important to them as a person (154). When it comes to pain and pain assessment, the definition from IASP (40) states that the subjective experience is the gold standard and also that the inability to communicate pain does not negate the possibility to experience pain.…”

Section: Person-centered Carementioning

confidence: 99%

Pain in intensive care: assessments and patients’ experience

Hylén¹

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The aim of the thesis was to translate, psychometrically test, and further develop the Behavioral Pain Scale for pain assessment in intensive care and to analyze if any other variables (besides the behavioral domains) could affect the pain assessments. Furthermore, the aim was to explore the patients’ experience of pain within the intensive care. The Behavioral Pain Scale (BPS), consisting of the domains “facial expression,” “upper limbs,” and “compliance with ventilator/vocalization,” was translated andculturally adapted into Swedish and psychometrically tested in a sample of 20 patients(study I). The instrument was then further developed within one of the domains and tested for inter-rater reliability, discriminant validity, and criterion validity (study II). The method for analysis in both study I and II was a method specifically developed for paired, ordered, and categorical data. To describe and analyze the process of pain assessment, a General Linear Mixed Model was used to investigate what variables, besides the behaviors, could be associated with the observers’ own assessment of the patients’ pain (study III). Further, the patients’ experiences of pain when being cared for in intensive care were explored (study IV) through interviews with 16 participants post intensive care. Qualitative thematic analysis with an inductive approach was used for the analysis. The first psychometric tests of the BPS (study I) showed inter-rater reliability with agreement of 85%. For the discriminant validity, all domains, except “compliance with ventilator,” indicated discriminant validity. Therefore, in study II, a developed domain of “breathing pattern” was tested alongside the original version. The BPS showed discriminant validity for both the original and the developed version and an inter-rater reliability with agreement of 76-80%. Wheninspecting the respective domains there was a difference in discriminant validity between the original domain of “compliance with ventilation” and the developed domain of “breathing pattern,” showing higher values on the scale for the developed domain during turning. For criterion validity, the BPS showed a higher sensitivity than the observers, who on the contrary had a higher specificity.The General Linear Mix Model (study III) showed that heart rate could be associated with the observers’ assessments of pain. For the behavioral signs, the result indicated that breathing pattern was most associated with the observers’ pain assessment, whilst facial expression did not show any impact on the observers’ assessments. The patients’ experiences of pain (study IV) in intensive care were described as generating a need for control; they experienced a lack of control when pain was present and continuously struggled to regain control. The experience of pain was not only related to the physical sensation but also to psychological and social aspects, along with the balance in the care given, which was important to the participants. In conclusion, the translated and developed version of the Swedish BPS showed promising psychometric results in assessing pain in the adult intensive care patients. Still, other signs, besides behavioral, is possibly used when pain assessing and therefore information about and training in pain assessment are needed to enhance the assessments that are made. Also, the patients’ own experiences highlight the importance of individualizing and adapting pain assessment and treatment to the needs of each patient. Making them a part of the team could enhance their feeling of control, thereby supporting them in facing the experience of pain.

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An integrative review of supports, facilitators and barriers to patient‐centred nursing in the intensive care unit

Abstract: Measures to enhance patient-centred nursing could promote critical care nurses' job satisfaction and workforce retention, and be applied more broadly and collaboratively to promote multidisciplinary patient-centred care.

Cited by 26 publications

References 37 publications

Intensive Care Nurses’ Experiences of Caring for Intubated Patients under Light Sedation: A Qualitative Study

Intensive Care Nurses’ Experiences of Caring for Intubated Patients under Light Sedation: A Qualitative Study

Insights on compassion and patient‐centred nursing in intensive care: A constructivist grounded theory

Pain in intensive care: assessments and patients’ experience

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