The visitor's regard of their need for support, comfort, information proximity and assurance in the intensive care unit
To describe the relationships between demographic variables and the need for support, comfort, information, proximity and assurance amongst the visitors at the intensive care unit (ICU).
In a cross-sectional correlational design, data were collected from March 2008 to January 2009 at a university hospital in the city of Oslo, Norway. The Critical Care Family Needs Inventory was used to collect data on the participants' perceived need for support, comfort, information, proximity and assurance. One hundred and forty-six questionnaires were given to the visitors of 74 patients, and 62 (42.5%) responded.
The bivariate analyses showed that younger visitors regarded their need for comfort, information, proximity and assurance as more important than older visitors. Women reported a need for more comfort than men. Visitors with a lower level of formal education regarded their need for more support and comfort as more important than those with a higher educational level. After controlling for other socio-demographic variables, linear regression analysis showed that low educational level was directly related to greater need for support, comfort and proximity.
Professionals should pay special attention to the needs of younger visitors to the ICU, females and those with a low level of education.
Available from: Sebastiano Mercadante
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ABSTRACT: Anesthesiologists may face problematic situations when patients are close to death, in which clinical problems, decision-making processes, and ethical issues are often interconnected and dependent on each of them. The aim of this review is to assess the recent literature regarding the anesthesiological role for advanced cancer patients.
Palliative sedation in the dying patients, end-of-life problems in the ICU, and pain control in advanced cancer patients have been the subject of recent research. All these issues have shown that anesthesiologist would be expert in the field of pain and symptom control at the end of life. End-of-life care problems are common in ICU, and a decision-making process requires knowledge and management of patients' wishes, past and projected future quality of life, severity and prognosis of illness, patients' age, regarding withholding and withdrawing of futile treatments in anticipation of death, or relieving symptoms close to death.
Anesthesiologists should be competent in all aspects of terminal care, including the practical and ethical aspects of withdrawing different modalities of life-sustaining treatment and the use of sedatives, analgesics, and nonpharmacologic approaches to easing the suffering of the dying process. More research is needed to provide models which should be spread in the scientific community to afford this difficult task.
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ABSTRACT: To explore the meaning of vigilant attendance for relatives of critically ill patients in Greece.
A plethora of international research has identified proximity to the patient to be a major concern for relatives of critically ill patients. Greece however follows a strict visiting policy in intensive care units (ICUs) so Greek relatives spend great amounts of time just outside the ICUs.
This qualitative study adopted the social constructionist version of grounded theory.
Data were collected from three ICUs in Athens through in depth interviews with 25 informants and approximately 10 h of observations outside the ICUs on 159 relatives.
Vigilant attendance was one of the main coping mechanisms identified for relatives. Four subcategories were found to comprise vigilant attendance: (1) being as close as possible to feel relief, (2) being there to find out what is going on, (3) monitoring changes in the loved one and making own diagnosis and (4) interacting with the ICU professionals.
Vigilant attendance describes the way in which relatives in Greece stayed outside the ICUs. Relatives felt satisfaction from being close as the best alternative for not actually being inside the ICU and they tried to learn what was going on by alternative methods. By seeing the patients, relatives were also able to make their own diagnoses and could therefore avoid relying solely on information given to them. However, a prerequisite for successful vigilant attendance was to get on well with doctors and nurses.
Changes in visiting policies in Greece are needed to meet the needs of relatives adequately. Recommendations for changes with minimal investment of time and funding are made.
Available from: Erwin J O Kompanje
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To examine the potential of a questionnaire (CQI ‘R-ICU’) to measure the quality of care from the perspective of relatives in the intensive care unit (ICU).
A quantitative survey study has been undertaken to explore the psychometric properties of the instrument, which was sent to 282 relatives of ICU patients from the Erasmus MC, an academic hospital in Rotterdam, the Netherlands. Factor-analyses were performed to explore the underlying theoretical structure.
Survey data from 211 relatives (response rate 78%) were used for the analysis. The overall reliability of the questionnaire was sufficiently high; two of the four underlying factors, namely ‘Communication’ and ‘Involvement’, were significant predictors. Two specific aspects of care that needed the most improvement were missing information about meals and offering an ICU diary. There is a significant difference in mean communication with nurses among the four wards in Erasmus MC, Conclusions The CQI ‘R-ICU’ seems to be a valid, reliable and usable instrument. The theoretical fundament appears to be related to communication.
The newly developed instrument can be used to provide feedback to health care professionals and policy makers in order to evaluate quality improvement projects with regard to relatives in the ICU.
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