The evidence base of nurse-led family interventions for improving family outcomes in adult critical care settings: A mixed method systematic review

Kiwanuka, Frank; Sak‐Dankosky, Natalia; Alemayehu, Yisak Hagos; Nanyonga, Rose Clarke; Kvist, Tarja

doi:10.1016/j.ijnurstu.2021.104100

Cited by 15 publications

(13 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The effectiveness of addressing family needs of critically ill patients involves support groups in and out of ICU, structured communication and/or education programs, providing information brochures to meet family needs or the use of diaries [ 58 ]. Nurse-led interventions for improving family outcomes in the ICU include educational interventions with digital storytelling, bundled approach, informational nursing interventions, and nurse-driven emotional support [ 59 ]. All these interventions help promote family involvement in their loved one's care and facilitate their decision-making capacity, improving clinician and family interaction, comprehension of the patient’s condition and reduce the development of PTSD.…”

Section: Patient and Family Centered Carementioning

confidence: 99%

The future of intensive care: delirium should no longer be an issue

et al. 2022

View full text Add to dashboard Cite

In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.

show abstract

Section: Patient and Family Centered Carementioning

confidence: 99%

The future of intensive care: delirium should no longer be an issue

et al. 2022

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Given the state of research in the field of family intervention in the context of critical illness [ 22 , 24 – 26 , 121 , 122 ], rigorous real-world evidence generated by a randomized controlled design is now necessary. There is a clear need to clarify the clinical effectiveness of specific, yet multicomponent or bundled, nurse-led family interventions [ 24 ] that build on guideline-based recommendations for family care in the ICU [ 15 ]. Two groups have already tested similar multicomponent interventions combining communication and support with a family navigator role [ 30 , 38 ], which have shown promising effects on the quality of family care but less clear effects on post-ICU family member health.…”

Section: Discussionmentioning

confidence: 99%

“…While there is a general trend towards improved communication, decision-making, and family satisfaction and reports of reduced symptoms of anxiety, depression, and post-traumatic stress following such family interventions, effects were mostly found to be statistically non-significant with unclear clinical significance. The effects on length of ICU stay remain controversial [ 21 , 22 , 27 ], and most studies have used non-controlled designs [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…The qualitative evaluation showed self-perceived benefits for family management of critical illness and its aftermath when the intervention is initiated shortly after ICU admission, responsive to families’ unique needs, and perceived to be delivered with high proficiency [ 32 ]. The pre-existing evidence base around multicomponent family support interventions is modest and requires further substantiation, particularly using randomized controlled designs [ 24 – 26 ]. Hence, the here proposed trial seeks to generate high-quality evidence on the intervention effectiveness of such multicomponent, bundled family support interventions in ICU while also generating knowledge around implementation processes and outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A multicomponent family support intervention in intensive care units: study protocol for a multicenter cluster-randomized trial (FICUS Trial)

Naef

Filipovic

Jeitziner

et al. 2022

Trials

View full text Add to dashboard Cite

Background Family members of critically ill patients face considerable uncertainty and distress during their close others’ intensive care unit (ICU) stay. About 20–60% of family members experience adverse mental health outcomes post-ICU, such as symptoms of anxiety, depression, and posttraumatic stress. Guidelines recommend structured family inclusion, communication, and support, but the existing evidence base around protocolized family support interventions is modest and requires substantiation. Methods To test the clinical effectiveness and explore the implementation of a multicomponent, nurse-led family support intervention in ICUs, we will undertake a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 1 trial. It will include eight clusters (ICUs) per study arm, with a projected total sample size of 896 family members of adult, critically ill patients treated in the German-speaking part of Switzerland. The trial targets family members of critically ill patients with an expected ICU stay of 48 h or longer. Families in the intervention arm will receive a family support intervention in addition to usual care. The intervention consists of specialist nurse support that is mapped to the patient pathway with follow-up care and includes psycho-educational and relationship-focused family interventions, and structured, interprofessional communication, and shared decision-making with families. Families in the control arm will receive usual care. The primary study endpoint is quality of family care, operationalized as family members’ satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and family members’ mental health (well-being, psychological distress) measured at admission, discharge, and after 3, 6, and 12 months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference. Discussion This trial will examine the effectiveness of the family support intervention and generate knowledge of its implementability. Both types of evidence are necessary to determine whether the intervention works as intended in clinical practice and could be scaled up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being. Trial registration ClinicalTrials.gov NCT05280691. Prospectively registered on 20 February 2022.

show abstract