Family stresses, strengths, and outcomes after critical injury.

Because critical injury occurs without warning, there is no time for families to prepare for this event. Stresses caused by critical injury vary in intensity and duration but certainly have the potential to create a heavy burden on family members. Prior family stress seems to be the salient indicator of the amount of assistance a family will need. The number of stresses not directly associated with the critical injury seems to be an important predictor of family adaptation outcomes. Therefore, it is important that nurses assess other stresses occurring in the family, not focusing solely on the stresses associated with critical injury. Interventions that help mobilize family strengths may be effective strategies for promoting family adaptation outcomes. Families using few coping strategies or reporting reduced resources, or both need referrals to other health care professionals or advanced practice nurses. Patient and family care conferences also may be helpful in the development of intervention plans to mobilize individual family strengths after critical injury.

Caregiver satisfaction with preparation for discharge in a decreased-length-of-stay cardiac surgery program.

Preparing caregivers of cardiac surgery patients for early discharge is an essential component of patient care. This study examined caregiver satisfaction with preparation for discharge in a decreased length of stay cardiac surgery program. Data were obtained from caregivers (N = 53) of cardiac surgery patients discharged on postoperative day 4 or 5. Data were analyzed with regard to caregiver satisfaction with preparedness for discharge, preference for a longer hospitalization, benefit of an earlier discharge, and patient care expectations. Results indicted that the majority of caregivers preferred earlier discharge but did not feel prepared for the responsibility of patient care. Implications for education and support for the caregiver before early discharge are addressed.

Impact of family demands and family strengths and capabilities on family well-being and adaptation after critical injury.

BACKGROUND: Increases in demands on patients' family members that are not reduced by family strengths may contribute to decreases in family adaptation and complicate patients' recovery after trauma. The purpose of this study was to examine family demands (prior stressors and severity of patients' injuries) and family strengths and capabilities (hardiness, resources, coping, and problem-solving communication) associated with outcomes of family well-being and adaptation. METHODS: A multivariate, descriptive design based on the Resiliency Model of Family Stress was used. A convenience sample of family members (N = 51) of adult patients participated within the first 2 days of critical injury. Family demands were measured with the Family Inventory of Life Events and Changes and the Acute Physiology, Age, and Chronic Health Evaluation III. Family strengths were measured with the Family Hardiness Index, Family Inventory of Resources for Management, Family Crisis Oriented Personal Evaluation Scale, and Family Problem Solving Communication Index. Family adaptation outcomes were measured with the Family Well Being Index and Family Adaptation Scale. RESULTS: Increases in family demands were significantly related to decreases in family strengths and family adaptation. Family demands scores accounted for 40% of the variance in family well-being scores. The only significant family strength variable influencing family adaptation was problem-solving communication. CONCLUSIONS: Increases in family demands seem to be an important indicator of the amount of assistance a family may need. Interventions that help mobilize family strengths, such as problem-solving communication, may be effective in promoting the adaptation of families of critically injured patients.

Arrhythmia detection and response in a monitoring technician and pocket paging system.

Technologically advanced telemetry systems have begun to produce alternatives to the need for continuous visual observation of the electrocardiogram (ECG). Few studies have been conducted to determine the efficacy of these systems in the clinical setting. The purpose of this study was to describe two different approaches to communication of arrhythmia events and corresponding nurse response. One approach, on a cardiac medical unit, utilized a monitoring technician to continuously observe ECGs at a central monitoring technician station (MTS) and notify the nurse of changes. The other approach, on a general medical unit, eliminated the use of the monitoring technician and utilized a pocket paging system (PPS). The PPS interfaced with the computerized arrhythmia detection system from the ECG monitor, which directly alerted the nurse to arrhythmia events. A quasi-experimental comparative post-test design was used. The sample consisted of 50 randomly selected, 2-hour observation periods on each unit during a 3-month period. Data collectors recorded the interaction of the monitoring technician with the arrhythmia detection system and the nurse on the MTS unit, or the nurse using the PPS. Results of this study revealed all arrhythmia events activated an alarm by the computerized arrhythmia detection system. Length of time to notify the nurse was within 0 to 1 minute for both systems. This study demonstrated that the PPS is a viable approach to arrhythmia detection and communication in the medical/cardiac patient population.

Treatment for family members in crisis after critical injury.

A sudden critical injury produces a great amount of stress within a family. Families faced with this experience require treatment to modify the stress of the situation, receive and comprehend information, maintain patterns of adequate family functioning, use effective coping skills, and provide positive support to the patient. Specific questions discussed include: Who are family members? Why treat family members who are in crisis? What areas should be included in family assessment? What treatments are effective for families? What family outcomes can be expected? A clinical case study is used to describe assessment areas and initial treatments for family in crisis after one of their members is critically injured.

Intraoperative progress reports decrease family members' anxiety.

The researcher used a four-group quasi-experimental posttest design to examine the effect of intraoperative progress reports on 200 family members' anxiety. Group one (ie, control group) received standard perioperative care, which did not include intraoperative progress reports. Group two received in-person progress reports from perioperative nurses. Group three received an "attention" protocol (ie, checklist explaining hospital routines, waiting room procedures). Group four received progress reports delivered by telephone. The researcher compared family members' state anxiety scores, mean arterial pressures (MAPs), and heart rates measured halfway during their relatives' surgical procedures, measuring these dependent variables after providing the interventions. The in-person intraoperative progress report group reported lower state anxiety scores (P < .001) and had significantly lower MAPs and heart rates (P < .05) than the other three groups. In-person progress reports appear to be the most beneficial perioperative nursing intervention for reducing family members' anxiety during the intraoperative waiting period.

Interventions for aged family members.

Is Mrs. B's family unusual? Is this a hypothetical situation made too dramatic? The answer is no, to both questions. This situation is real, the family is real, and a typical, elderly spouse was driven to feel helpless and out of control, experiencing what no person should ever go through, and needing to reevaluate and rethink her whole future. Hospitalization for a critical injury can disrupt even the most highly organized and functional family. Family-focused care may mitigate family stress by providing support based on the unique needs of each family. As Mrs. B's family illustrates, the family members may have suffered as much pain as the patient. They, too, deserve special attention and consideration. Their reactions are typical and manageable, and professionals who are interested in the welfare and functioning of the family must ensure that the family of the patient receives adequate and appropriate care, no matter what their age.

Effects of intraoperative progress reports on anxiety levels of surgical patients' family members.

A three-group quasi-experimental posttest-only design was used to examine the effectiveness of intraoperative progress reports by comparing family members' state-anxiety score, mean arterial pressure level (MAP), and heart rate during elective surgical procedures. Control-group family members (n = 50) received usual care. Family members in the experimental group (n = 50) received a 5- to 10-minute progress report protocol about halfway through a surgical procedure. An additional group of family members (n = 50) received an attention protocol. Family members in the experimental group reported lower state-anxiety scores (p < .001) and had significantly lower MAP levels (p < .001) and heart rates (p < .01) compared with the control and attention groups. Progress reports appear to be a beneficial independent nursing intervention for reducing anxiety in family members during the intraoperative waiting period.

Models and processes of research utilization.

The proliferation of research in nursing is greater today than at any other time in the history of nursing. In order for this research to be meaningful for practice, research utilization efforts are imperative. This article reviews three prominent research utilization models spanning three decades of development. Future challenges and suggestions for improving the process are identified. Through research utilization efforts, nurses are given the power to make informed choices regarding implementation of research-based assessments, diagnoses, interventions, and outcome measures that ultimately will result in improved patient outcomes.

Using clinical innovations for research-based practice.

Making choices about patient-care interventions pervades critical care nursing practice. Research utilization activities provide the reasoning by which assessment parameters are established, preventative actions are identified, and interventions are evaluated in the clinical setting for positive effects on patient outcomes. For research results to be directly applicable, they must be transformed into clinical innovations specific to a patient population, clinical situation, or institutional setting. A brief summary of using research findings to design clinical innovations is provided. Examples of selected clinical innovations are included to illustrate the steps of the research utilization process. Clinical innovations are intended to improve or validate patient outcomes and are considered the key to quality patient care.

Anxiety of elective surgical patients' family members. Relationship between anxiety levels, family characteristics.

Technological advances in the OR create new practices and procedures; however, humanistic and holistic approaches to nursing care remain the foundation of clinical practice. Perioperative nurses recognize that family members experience anxiety during surgery, especially during the time the patient is in the OR. Ironically, it is during this time period that little or no meaningful communication occurs between family members and health professionals. Patients continue to be discharged sooner, and in sicker condition, to be cared for by their family members. Families require information about how to provide postoperative care. Anxiety levels need to be decreased sufficiently to allow family members to use the information they are taught and ask appropriate questions. Interventions that reduce family members' anxiety need to be developed and tested so that family members can help patients after surgery. Using research findings as a basis for perioperative nursing practice may mean changing traditions and attitudes about family members of surgical patients. In the consumer-oriented climate of current health care, doing the "new" may make a difference in the market share. This "new" may be independent nursing interventions designed to reduce family members' anxiety during the intraoperative waiting period.

Needs of adult family members after critical illness: prescriptions for interventions.

Concerns for family members of critically ill patients are evident in nursing literature; however, assessment parameters and intervention strategies during the critical care experience require further consideration. This article reviews the results of prior published and unpublished nursing research pertaining to needs of adult family members after critical illness. Selected nursing interventions are provided to encourage practitioners and researchers to develop, test, and evaluate those activities that most effectively meet various types of family-member needs.

Comparison ratings of need importance after critical illness from family members with varied demographic characteristics.

This descriptive study compares ratings of importance of selected needs by family members after the first 3 days of critical illness with family member age, gender, relationship to patient, prior intensive care unit experience, and patient medical diagnosis. Family-need importance ratings from 905 subjects, collected by 27 nurse investigators in 15 states over a 10-year period (1980 to 1989) were used as an aggregate data base. Bivariate t tests and analysis of variance procedures were used to compare ratings of importance for support, comfort, information, proximity, and assurance needs with family member demographic characteristics. Results indicated that there were more similarities than differences on the ratings of importance for selected needs from various family members. Focusing on these similarities should be useful for developing and testing nursing interventions to help family members meet their needs after a critical illness event.

Needs of families of critically ill patients: state of the science and future directions.

This article provides an overview of the needs of families of critically ill patients and offers suggestions for future research. Continuous, systematic study about the needs of families of critically ill patients is necessary for nursing to be responsive to the health care needs of society in the 21st century.

The impact of critical injury as described by a spouse: a retrospective case study.

This descriptive study explored the initial experience of critical injury from a spouse's perspective. A case study was used to examine the Lazarus stress and coping paradigm. The subject was 43-year-old Caucasian woman, with three young children. Semistructured interviews were conducted 1 month following critical injury. Analysis of data confirmed the cognitive, behavioral, and emotional coping processes as suggested by Lazarus. From the spouse's description, three distinct phases of the critical care experience also emerged: notification, arrival at the hospital, and waiting periods. Cognitive, behavioral, and emotional coping processes were clustered according to the spouse's distinct phases of this experience. A 3 x 3 matrix provides a description of the coping processes during the initial critical care period and offers direction for nursing interventions.

Use of the nursing minimum data set.

The purpose of this study was to obtain information about usage of the Nursing Minimum Data Set (NMDS). Forty-six individuals (44%) who requested the NMDS Data Collection Manual responded to a mailed questionnaire. Most respondents reported actually using the Manual to educate other nurses or to structure nursing documentation. More than one third of the respondents used all of the elements within the NMDS, but the majority used, or intended to use, the elements in the Nursing Care category. The majority of NMDS elements that were being used, or intended to be used, were available from handwritten patient records. The NMDS elements had been recorded on an ongoing basis by 86% of the respondents, but only 31% could retrieve readily all of the elements. Implications for access to comparable, minimum nursing care and resources data are discussed.

Effects of intraoperative progress reports on anxiety of elective surgical patients' family members.

The purpose of this experimental study was to examine the effects of intraoperative progress reports on family members' state anxiety level (STAI S-Anxiety), mean arterial pressure (MAP), and heart rate during elective surgical procedures. Family members of randomly selected surgical patients were eligible to participate. Control group family members (n = 50) received usual care. Family members in the experimental group (n = 50) received a 5- to 10-minute progress report protocol about halfway through a surgical procedure. Families' STAI S-Anxiety scores, MAP, and heart rates were compared between the control and experimental groups using multivariate analysis of variance (MANOVA). Family members in the experimental group reported lower STAI S-Anxiety scores (p < .001), and had significantly lower MAP and heart rates than did the control group (p < .001). Progress reports appear to be a beneficial nursing intervention for reducing anxiety in family members during the intraoperative period.