ABSTRACT
Background: Involving family caregivers in direct care in the intensive care unit is increasingly recognized as part of best care practices. However, little is known about the factors that foster this involvement. Objective: The aim of this study was to identify the factors in the literature that promote or limit the involvement of family caregivers in direct care in adult intensive care units. Method: A rapid literature review was conducted in MEDLINE and CINAHL for English-and French-language articles published between 2010 and 2021. Results: 25 articles were selected (n=20 primary studies, n=5 literature syntheses). The results show a diversity of factors that influence the involvement of relatives in direct intensive care units. These factors can be grouped into four categories : relational, informal, clinical, and political. Conclusion: This review identifies the organizational, clinical and human issues relating to the involvement of family caregivers in direct care in order to propose recommendations to facilitate the implementation of this approach in the intensive care units.
Contexte: L'implication des proches aidants dans les soins directs à l'unité des soins intensifs est de plus en plus reconnue comme faisant partie des meilleures pratiques de soins. Toutefois, les facteurs permettant de favoriser cet engagement sont peu connus. Objectifs: Cette étude vise à identifier dans la littérature les facteurs favorables ou limitant l'implication des proches aidants dans les soins directs dans les unités des soins intensifs adultes, et à proposer des recommandations pour favoriser cette implication. Méthode: Une revue rapide des écrits a été réalisée dans MEDLINE et CINAHL afin d'étudier les articles publiés entre 2010 et 2021 en français ou en anglais. Résultats: Au total, 25 articles ont été retenus (n = 20 études primaires, n = 5 synthèses des connaissances). Conclusion: Cette revue permet d'identifier les enjeux organisationnels, cliniques et humains relatifs à l'implication des PA dans les soins directs afin de proposer des recommandations pour faciliter l'implantation de cette approche dans les unités des soins intensifs.
Subject(s)
Caregivers , Critical Care , Family , Humans , Caregivers/psychology , Critical Care/psychology , Critical Care/methods , Critical Care/standards , Family/psychology , Intensive Care Units/organization & administration , Professional-Family RelationsABSTRACT
ABSTRACT: BACKGROUND: Delirium is a common neurological complication in patients admitted to the intensive care unit (ICU) after moderate to severe traumatic brain injury (TBI). Although current clinical guidelines prioritize delirium prevention, no specific tool is tailored to detect early signs of delirium in TBI patients. This preliminary 2-phase observational study investigated the correlation between the pupillary light reflex (PLR), measured with a pupillometer during mechanical ventilation, and the development of postextubation delirium in TBI patients. METHODS: A convenience sample of 26 adults with moderate to severe TBI under mechanical ventilation was recruited during their ICU stay. In phase I, PLR measurements were performed in the first 3 days of ICU admission using automated infrared pupillometry. In phase II, 2 raters independently extracted delirium data in the 72 hours post extubation period from medical records. Delirium was confirmed with a documented medical diagnosis. Point-biserial correlations (rpb) were used to examine the association between PLR scores and the presence of postextubation delirium. Student t tests were also performed to compare mean PLR scores between patients with and without delirium. RESULTS: Ten TBI patients (38%) were diagnosed with postextubation delirium, whereas 16 (62%) were not. Significant correlations between delirium and 2 PLR variables were found: pupil constriction percentage (rpb(24) = -0.526, P = .006) and constriction velocity (rpb(24) = -0.485, P = .012). The t test also revealed a significant difference in constriction percentage and velocity scores between TBI patients with and without delirium (P ≤ .01). CONCLUSION: Our findings suggest that the use of pupillometry in the first 3 days of mechanical ventilation during an ICU stay may help identify TBI patients at risk for delirium after extubation. Although further research is necessary to support its validity, this technological tool may enable ICU nurses to better screen TBI patients for delirium and prevent its development.
