Healthcare professionals perspective of the facilitators and barriers to family engagement during patient-and-family-centered-care interdisciplinary rounds in intensive care unit: A qualitative exploratory study.

OBJECTIVES: Family engagement in care for critically ill patients remains an inconsistent practice and an understudied area of nursing science. Rounds for this study is an interdisciplinary activity conducted at the bedside in partnership with patients, their families, and the health care professionals involved in providing the care. We sought to explore and describe the facilitators and barriers to family engagement during patient and family-centered interdisciplinary rounds in the intensive care unit. RESEARCH METHODOLOGY/DESIGN: This qualitative exploratory study is part of a multisite experimental study (#Pro2020001614; NCT05449990). We analyzed the narrative data from the qualitative questions added in the survey from 52 healthcare professionals involved in a multisite experimental study using Braun and Clarke's (2006) constructionist, contextualist approach to thematic analysis. SETTING: The study was conducted in the intensive care unit of two medical centers. MAIN OUTCOME MEASURES: The findings presented are themes illuminated from thematic analysis namely communication gaps, family's lack of resources, familial and healthcare providers' characteristics, lack of leadership, interprofessional support, policy, and guidelines. FINDINGS: Family engagement in critical care during interdisciplinary rounds occurred within the intersectionality among families, healthcare professionals' practice, and organizational factors. The facilitators for family engagement include supported, championed, and advocated-for family adaptation, teams, and professional practice, and organizational receptivity, and support. Communication and leadership are the precursors to family engagement. CONCLUSIONS: The findings added new knowledge for exploring the nature and scope of family engagement in critical care. Family engagement must be incorporated into the organizational vision and mission, and healthcare delivery systems. IMPLICATIONS FOR CLINICAL PRACTICE: There is a need to further investigate the resources, organizational support mechanisms, and systems that affect patients, families, and healthcare professionals, and the establishment of policies that will aid in reducing barriers to family engagement in the intensive care unit.

A Concept Analysis of Family Presence During COVID-19.

BACKGROUND: In 2020, the COVID-19 pandemic required health care organizations throughout the United States to implement strict visitor restriction policies to mitigate the spread of the virus. These policy changes had a direct impact on family presence (FP) in hospital settings. PURPOSE: The aim of this study was to conduct a concept analysis of FP during the COVID-19 pandemic. METHODS: Walker and Avant's 8-step method was used. RESULTS: Four defining attributes of FP during COVID-19 were derived based on a review of the literature: being there or with, seeing is believing, during challenging times, and subjective advocates. The COVID-19 pandemic was the main antecedent of the concept. The consequences and empirical referents were discussed. Model, borderline, and contrary cases were developed. CONCLUSION: This concept analysis provided an understanding of the concept of FP during COVID-19, which is imperative to optimizing patient care outcomes, as literature identified a support person or system as an extension of the care team that facilitates successful care management. Whether by advocating for their patients to have a support person present during team rounds, or by stepping in as the patient's main support system in the absence of family, nurses must find a way to do what is best for their patients even during the unprecedented times of a global pandemic.

"Sense of Presence" in Immersive Virtual Reality Environment: An Evolutionary Concept Analysis.

There is no concept analysis in the literature about "sense of presence" in immersive virtual reality environment in the context of nursing clinical education. The purpose of this article is to explore the meaning and derive an operational definition of the concept of sense of presence within the context of immersive virtual reality environment in nursing clinical education. Using Rodgers' approach, this evolutionary concept analysis will clarify the concept's surrogate and related terms, attributes, antecedents, and consequences. A clearer conceptualization is paramount to help provide knowledge for nurses and other health care professionals, thus guiding their practice, theory, and research.

COVID-19: The economic impact of a pandemic on the healthcare delivery system in the United States.

The COVID-19 pandemic has created an unprecedented economic crisis and significant impact to the healthcare system of the United States. The tasks facing leaders and policymakers are enormous. There is an urgent need for new, clear, collaborative, and transparent interventions based on evidence and science. The purpose of this article is to describe and evaluate the economic impact of the pandemic to the health care system, and the policy and recommendations that will help in the recovery process. A discussion of the economic impact to healthcare will be presented first including the interventions that successfully worked and are currently still appropriate. New and innovative interventions and recommendations are explored and suggested. It is made clear that the challenges involved in combating the situation are global and requires multisectoral, public and private cooperation across communities, and the nation if they are to be dealt with effectively.

Asking "Meaning Questions" in Evidence-Based Reviews and the Utility of Qualitative Findings in Practice.

Evidence-based practice (EBP) systematic reviews are mostly conducted using etiology, diagnosis, therapy, prevention, and prognosis question format. "Meaning" or qualitative questions are very rarely used. The purpose of this article is to discuss qualitative findings' contribution to EBP through asking "meaning questions" in conducting systematic reviews and the utilization of the results to practice. Two EBP systematic review exemplars using meaning questions including the relevance and utilization of qualitative findings in health care decision-making, practice, and policy are presented. There is a need to instill an evidence-based mindset into systematic reviews that balance scientific knowledge gained through empirical research and evidence from qualitative studies. This is turn will increase awareness among clinicians and decision makers on the different ways in which qualitative evidence can be used and applied in practice.

Collective trauma: An evolutionary concept analysis.

The purpose of this article is to explore the meaning, and derive an operational definition, of the concept of collective trauma. A search of the databases CINAHL, Ovid MEDLINE, and PsychInfo revealed no concept analysis about collective trauma. Using Rodger's approach, this evolutionary concept analysis clarifies the concept's surrogate and related terms, attributes, antecedents, and consequences, and proposes a derived definition. A clearer conceptualization of collective trauma is crucial for nurses and other health care professionals in their practice, theory and research.

Fostering Effective Mentoring Relationships in Qualitative Research.

Conducting a qualitative research study is a long, arduous, and laborious endeavor. The novice and early-career researchers, including graduate students, can be overwhelmed by the complexity of the methods used in conducting a naturalistic inquiry. Despite the recognized importance of mentoring in different fields, a research supervisor is almost always used to guide the neophytes in their pursuit of completing a research investigation in nursing. Supervising is task-oriented, whereas mentoring involves caring, role-modeling, emotional support, and guidance including the long-term development of the mentee. Research mentoring relationships are critical to the satisfaction of both the mentor and the mentee that leads to a successful completion of a qualitative inquiry and, eventually, for their academic and professional advancement. Mentees are advised to seek mentors and to establish formal mentoring relationships with them. It is also suggested that institutions support the value and work of mentors. Future studies must address failed mentoring liaisons, and assess and use different strategies for effective mentorship for both the mentor and the mentee. The purpose of this article is to discuss the role of mentoring in successfully completing a scholarly inquiry that will help in equipping novices with the knowledge, skills, and confidence that will empower them to navigate the difficult and long journey of a qualitative investigation.

Qualitative Research: Challenges and Dilemmas.

Considering the inductive nature of qualitative studies, the research process can be challenging to novices and doctoral students at every step. Appropriate planning should be in place before the commencement of the fieldwork, as well as to be able to address any methodological contingencies that emerge during the process. Challenges and dilemmas occur at different stages of the endeavor, namely, when selecting a topic, exploring the literature, selecting the setting, protecting the rights of participants, choosing a methodology and a research design, and collecting, managing, and analyzing data. This article aims to illuminate the quandaries of a naturalistic inquiry and to teach and recommend approaches to better address them. Providing researchers with the necessary and appropriate skills may help provide applicable and trustworthy study findings and outcomes. Hence, these recommendations need to be well defined and presented.

Data Analysis Software in Qualitative Research: Preconceptions, Expectations, and Adoption.

Research shows that more and more qualitative researchers now use computer software for qualitative data analysis. However, concerns, problems, and misunderstandings continue among developers themselves and researchers about its merits, their preconceptions, expectations, and adoption of the technology. This article examines the role of computer-assisted qualitative data analysis software focusing on the methodological issues surrounding program use and identifies the factors that result to unrealistic expectations of the innovation as a methodology in itself. The secondary aim is to help guide both the expert and novice qualitative critical care researchers on their decision making whether to use or not to use computer-assisted qualitative data analysis software in their studies. A brief review of 2 very common and widely used qualitative data analysis software packages will be presented. A section on making good use of supervision and mentorship in conducting a qualitative inquiry is included. Implications for its adoption and to qualitative research as a whole will be discussed.

Healing activities construct the objects of therapy: Medicine's way of seeking truth, organizing forms of reality, regulating patients' bodies, illness and culture?

In this paper, I will explore the concept that healing activities shape the objects of therapy and seek to construct those objects through therapeutic activities. Objects of therapy are the persons, patients, human bodies, diseases, physiological processes and personal suffering-that which clinical medicine constructs through its distinctive formative processes, practices and knowledge. The rationale for choice of philosophical sources namely, Cassirer, Foucault, the anthropological perspective of Good and the sociological account of Frank will be discussed. The claim articulated by Good will be examined and its relationship to culture, illness, medical knowledge, practice, truth, and science. I then focus on Frank's concepts of the patient and the body and how medical knowledge and practices affects it. The concept that the medicalization of the illness narrative silences the patient's voice requiring an ethic of listening will be emphasized, described and further supported by Charon's (2006, Narrative medicine: Honoring the stories of illness. New York, NY: Oxford University Press) and Cassell's (2015, The nature of suffering and the goals of medicine. New York, NY: Oxford University Press) thoughts on narrative of illness in clinical medicine. My position concludes that healing activities construct the objects of therapy: as the medical culture's way of seeking truth; as medicine's way of mediating and organizing forms of reality through culture and symbolic forms; and, as medicine's way of entering the body and constructing the disease. Lastly, I suggest that in spite of the remarkable progress in the control of disease, the failure to address the interpretation of illness meanings is a fundamental flaw in the work of "doctoring." The experience and meanings of illness are at the centre of clinical practice and is a moral, political, ethical and professional obligation. The person is a cultural construct, a complex and culturally shaped way of experiencing self and other, and cultural "work" is required to constitute the person who is the object of medical attention and it also necessitates the ethic of listening.

Qualitative Research Methods: A Phenomenological Focus.

Data collection and management are often neglected subjects of qualitative research. Qualitative data collection, management, and analysis are complex and challenging for researchers especially for early career and doctoral students. These processes involve anticipating for ethical issues and developing means and methods for collecting, recording, and storing data securely. Approaches to data analysis include organizing, reading, coding, and organizing themes, representing, and interpreting the data. The unanticipated issues in accomplishing these steps and corresponding solutions are presented. Recommendations for training and mentoring of novices in qualitative research are discussed.

Rigor or Reliability and Validity in Qualitative Research: Perspectives, Strategies, Reconceptualization, and Recommendations.

Issues are still raised even now in the 21st century by the persistent concern with achieving rigor in qualitative research. There is also a continuing debate about the analogous terms reliability and validity in naturalistic inquiries as opposed to quantitative investigations. This article presents the concept of rigor in qualitative research using a phenomenological study as an exemplar to further illustrate the process. Elaborating on epistemological and theoretical conceptualizations by Lincoln and Guba, strategies congruent with qualitative perspective for ensuring validity to establish the credibility of the study are described. A synthesis of the historical development of validity criteria evident in the literature during the years is explored. Recommendations are made for use of the term rigor instead of trustworthiness and the reconceptualization and renewed use of the concept of reliability and validity in qualitative research, that strategies for ensuring rigor must be built into the qualitative research process rather than evaluated only after the inquiry, and that qualitative researchers and students alike must be proactive and take responsibility in ensuring the rigor of a research study. The insights garnered here will move novice researchers and doctoral students to a better conceptual grasp of the complexity of reliability and validity and its ramifications for qualitative inquiry.

Exploring the Philosophical, Paradigmatic, Conceptual-Theoretical Underpinnings of Qualitative Research: A Focus on a Phenomenological Study in Intensive Care Unit.

Qualitative research has become more accepted as a legitimate mode of inquiry in the social and behavioral sciences for many years but not without controversy and confusion even now in the 21st century. The procedures for conducting a qualitative research study evolve from a philosophical, paradigmatic, and interpretive frameworks. These are the aspects of a naturalistic inquiry where inconsistency is evident related to its complexity. The purpose of this article is to describe qualitative methods focusing on these aspects that included phenomenology to set the stage for discussion and using a phenomenological study as an exemplar to further illustrate the process.

Understanding Uncertainty Among Critically Ill Patients in the Intensive Care Unit Using Mishel's Theory of Uncertainty of Illness.

BACKGROUND: The concept uncertainty has been explored in critical care but only among patients with myocardial infarction and post-cardiac catheterization using the Uncertainty in Illness Theory. Uncertainty is also a finding of numerous studies conducted in intensive care units (ICUs) that included only family members as participants of the research. OBJECTIVES: The purpose of this article is to explore, describe, and understand the concept of uncertainty among patients and family members during critical illness in the ICU from the perspective of a phenomenological study with support from other studies published in the literature using Mishel's Theory of Uncertainty in Illness. METHODS: The concept "uncertainty" as the topic for this article is one of the specific themes illuminated from a qualitative phenomenological study conducted in the ICU in 2010. Five from each category of patients, family members, and nurses were interviewed until data saturation was achieved. The data were analyzed using van Manen's wholistic, selective, and detailed line-by-line approach until themes were illuminated. RESULTS: Uncertainty is a patient-specific theme illuminated in this qualitative phenomenological study not noted among the family members. The patients perceived that they "do not know what is going to happen," "if they are progressing or not," or "if they will make it or not." DISCUSSION: Uncertainty among patients related to critical illness should be further explored. Patients with different critical care diagnosis should be included as participants.

Qualitative research: the "what," "why," "who," and "how"!

There has been a general view of qualitative research as a lower level form of inquiry and the diverse conceptualizations of what it is, its use or utility, its users, the process of how it is conducted, and its scientific merit. This fragmented understanding and varied ways in which qualitative research is conceived, synthesized, and presented have a myriad of implications in demonstrating and enhancing the utilization of its findings and the ways and skills required in transforming knowledge gained from it. The purpose of this article is to define qualitative research and discuss its significance in research, the questions it addresses, its characteristics, methods and criteria for rigor, and the type of results it can offer. A framework for understanding the "what," "why," "who," and "how" of qualitative research; the different approaches; and the strategies to achieve trustworthiness are presented. Qualitative research provides insights into health-related phenomena and seeks to understand and interpret subjective experience and thus humanizes health care and can enrich further research inquiries and be made clearer and more rigorous as it is relevant to the perspective and goals of nursing.

U.S.A.B.I.L.I.T.Y. Framework for Older Adults.

The purpose of the current study was to present a framework to determine potential usability of health websites by older adults. Review of the literature showed paucity of nursing theory related to the use of technology and usability, particularly in older adults. The Roy Adaptation Model, a widely used nursing theory, was chosen to provide framework for the new model. Technology constructs from the Technology Acceptance Model and United Theory of Acceptance and Use of Technology and behavioral control construct from the Theory of Planned Behavior were integrated into the construction of the derived model. The Use of Technology for Adaptation by Older Adults and/or Those With Limited Literacy (U.S.A.B.I.L.I.T.Y.) Model was constructed from the integration of diverse theoretical/conceptual perspectives. The four determinants of usability in the conceptual model include (a) efficiency, (b) learnability, (c) perceived user experience, and (d) perceived control. Because of the lack of well-validated survey questionnaires to measure these determinants, a U.S.A.B.I.L.I.T.Y. Survey was developed. A panel of experts evaluated face and content validity of the new instrument. Internal consistency of the new instrument was 0.96. Usability is key to accepting technology. The derived U.S.A.B.I.L.I.T.Y. framework could serve as a guide for nurses in formative evaluation of technology.

The process of transformation experienced by the patients, their families, and nurses during critical illness in the intensive care unit: perspective from a phenomenological study.

BACKGROUND: There are no studies in the literature that explore and describe the concept of transformation from the perspective of patients, family members, and nurses during critical illness in the intensive care unit (ICU). OBJECTIVES: The purpose of this article is to explore and describe the concept of transformation among patients, their families, and nurses during critical illness in the ICU. METHODS: The concept "transformation" is a theme illuminated from a qualitative phenomenological study conducted in the ICU in 2010. Fifteen participants were interviewed until data saturation was achieved. van Manen's holistic, selective, and detailed line-by-line approach was used to analyze the data until themes emerged. RESULTS: Processes of transformation related to ICU experience during critical illness were noted among the patients, family members, and nurses and presented in the following descriptors: (a) patients: a "wake-up call," "the longest days of my life," and "thankful to be alive"; (b) family members: "the experience made me emotionally empowered," and "the experience strengthened my faith"; (c) nurses: "the experience made me grow as a person," "the experience made me more enthusiastic for learning," and "realization that good care equals family satisfaction thus own personal satisfaction." DISCUSSION: The concept of transformation from the perspective of a triad of patients, their families, and nurses may be noted in other conditions other than critical illness; thus, replicating studies with different populations and settings is needed.

The emergency department: experiences of patients, families, and their nurses.

Research regarding the triad of nurses, patients, and family members looking at the lived emergency department experiences and their perspective of each from the other is notably absent. In this study, M. van Manen's (1990) hermeneutic phenomenological approach was used to explore, understand, and describe the lived experiences of nurses, patients, and family members during critical illness in the emergency department. Data were collected over a 6-month period by means of in-depth interviews. While nurses perceived that addressing the patient's physiological deficit promptly is paramount in the emergency department, they also indicated that including family members as coparticipants in the care is equally important. Patients and family members perceived that communication, critical thinking, sensitivity, and caring are necessary for emergency department nurses. The study supports recognizing the patient and family as active participants in the patient's medical care, encouraging family member presence, and creating institutional policies for patient- and family-centered care.

Using the synergy model of patient care in understanding the lived emergency department experiences of patients, family members and their nurses during critical illness: a phenomenological study.

Despite many studies conducted aimed to understand and improve emergency care, research on the triad of nurses, patients, and family members looking at the lived emergency department experiences and their perspective of each from the other is notably absent. In a hermeneutic phenomenological study using van Manen's method, a sample of 10 patients, 5 family members, and 8 nurses of a nonprofit community hospital was recruited and interviewed in 2010 to 2011 to explore, understand, and describe their lived experiences during critical illness in the emergency department. The nurses perceived that addressing the patient's physiologic deficit promptly is vital in the emergency department as well as including family members as coparticipants in the care. Patients and family members perceived that communication, critical thinking, sensitivity, and caring are essential for emergency department nurses. The American Association of Critical-Care Nurses' Synergy Model for Patient Care was applied in conceptualizing the findings and served as a framework in recommending practices and interventions geared toward improving competencies required in caring for critically ill patients and their families in the emergency department. The study supports recognizing the patient and family as active participants in the patient's medical care; encouraging family-member presence and creating institutional policies for patient- and family-centered care, as well as encouraging the development of ongoing programs that will recognize, enhance, and support the psychological and emotional well-being of emergency department nurses.

Transfer out of intensive care: an evidence-based literature review.

Critical care beds are a finite resource. Transfer or discharge of patients from the intensive care unit affects the flow of patients in critical care. Effective whole hospital bed management is key to the successful management of the critical care service. However, admission to the critical care unit alone can be extremely frightening, distressing, and traumatic not only for the patients but their families as well. Although transfer to the medical floors is a positive step toward physical recovery, it can be equally traumatic, and many patients and their families exhibit stress, fear, and anxiety. The purpose of this article was to systematically review the effects of intensive care unit transfer or discharge to medical-surgical floors on adult critically ill patients, their family members and nurses.