Barriers to patient and family‐centred care in adult intensive care units: A systematic review

Abstract

Aim Despite remarkable theoretical evidence of positive outcomes of patient and family‐centred care, it is rarely performed in the intensive care setting. The aim of this review was to assess the barriers to patient and family‐centred care among healthcare providers, patients and family members in adult intensive care units. Design A systematic review of both qualitative and quantitative studies. Methods The search strategy sought for published peer‐reviewed research papers limited to English language from conception to 2018. The review protocol was registered in the CRD Prospero database (CRD42018086838). Literature search was carried out in four databases: EMBASE, Cochrane Library, PubMed and Scopus where keywords “barriers,” “patient and family centered care,” “patient‐centered care” and “intensive care unit” appeared in any part of the reference. Hand search of reference lists of identified papers was also done to capture all pertinent materials. Each study was assessed by three independent reviewers against the inclusion criteria. Evidence was graded according to sampling quality, quantity and measurement of intended outcomes. Screening of studies and citations resulted in seven studies that were included in the analysis. Results Barriers to patient and family‐centred care broadly fall under four categories; lack of understanding of what is needed to achieve patient and family‐centred care, organizational barriers, individual barriers and interdisciplinary barriers.

A qualitative study of Ghanaian pediatric oncology nurses’ care practice challenges

“…In the current study, pediatric oncology nurses also experienced a lack of teamwork. This finding is in line with a study that acknowledged that there is a lack of interprofessional collaboration and there is a lack of clarity and accurate communication among oncology team members [ 25 , 28 ]. Participants also mentioned that they believe that their work makes them exposed to getting cancer.…”

“…As if that is not enough, there is also a shortage of assistant ward aids (trained nurses who does nonspecialized work such as transportation of patients) [27]. Other studies have also confirmed, inappropriate work environments such as nurse shortages, workload, high nurse-patient ratio, overcrowded hospitals, burnout of nurses, and poorly constructed pediatric oncology hospital wards [28][29][30]. Implementing a minimum nurse-to-patient ratio, will improve patient outcomes, reduce hospital stays, reduce admission rates and reduce the burnout rate of nurses.…”

A Qualitative study of Ghanaian pediatric oncology nurses’ care practice challenges.

“…They shared experience of how most of them try not to assist each other by responsibility-sharing when it comes to the time to administer chemotherapy medications. This nding is in line with a study that acknowledged that there is a lack of interprofessional collaboration and there is lack of clarity and accuracy communication among oncology team members (25,28). Participants also mentioned that they believe that their work makes them exposed to getting cancer.…”

“…In line with this current nding, a study also found out that there is a shortage of pediatric oncology nurses, as if that is not enough, there is also shortage of assistant ward aids, who are trained nurses to do nonspecialized work such as transportation of patients (27). Other studies have also con rmed, inappropriate work environments such: nurse shortages, no support to pediatric oncology nurses in achieving comprehensive care for children with cancer, workload, high nurse-patient ratio, overcrowded hospitals, burnout of nurses and lack of reinforcement of positive cancer supportive care behaviors and poor pediatric oncology care design (28)(29)(30). Implementing a minimum nurse-to-patient ratio, will improve patient outcomes, reduce hospital stays, and reduce admission rates.…”

What is the role of transformational leadership, work environment and patient safety culture for person‐centred care? A cross‐sectional study in Norwegian nursing homes and home care services

“…“time constraints”) and interdisciplinary barriers (e.g. “communication barriers between doctors and nurses) (Kiwanuka, Shayan, & Tolulope, 2019).…”