ABSTRACT
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.
Subject(s)
Critical Illness , Ficus , Adult , Anxiety/diagnosis , Anxiety/prevention & control , Critical Illness/therapy , Family/psychology , Humans , Intensive Care Units , Multicenter Studies as Topic , Randomized Controlled Trials as TopicABSTRACT
AIMS: To explore nurse-patient interactions during the Covid-19 pandemic from both nurses' and patients' perspectives. DESIGN: Qualitative study using constructive grounded theory. METHODS: A total of 34 patients and 49 nurses from acute and home care settings participated in individual or focus group interviews between December 2020 and May 2021. Data were analysed by a team of researchers using coding, memo-writing, theoretical sampling and constant comparison and integration. RESULTS: We identified the creation and maintenance of an interactive space as the main social process. This interactive space was shaped by the care context and the course of the pandemic. For nurses, four factors were key, namely protecting oneself and others, navigating communication barriers, adapting nursing actions to the evolving situation, and providing emotional care work. Patients experienced attentive caring relationships with nurses and felt that, for the most part, their individual needs had been met despite the pandemic challenges. CONCLUSION: Nurses and patients created an interactive space in which they were able to provide and receive the necessary care. Maintaining the interactive space was often challenging, and required an intentional effort by nurses, particularly in acute care settings. The findings illustrate that nurses ensured the provision of necessary care even during a public health crisis, thereby enabling patient access to good quality care. IMPACT: Nurse-patient relationships are important for effective, person-centred care delivery. Despite the pandemic challenges, nurses managed to uphold their caring imperative and ensure quality care. Findings provide further insights on the importance of nurse-patient interaction in maintaining quality care. They inform models of nursing care delivery and strategies to support quality care during public health crises.