Creating a collaborative environment to care for complex patients and families.

Today's critical care environment is increasingly complex due to technological advancements, greater intensity of interventions, and a myriad of healthcare providers. Critically ill patients and their families can feel overwhelmed with the stress of the environment in addition to the acute illness. This stress affects the patients' and families' ability to function, cope, and understand complex information. For some families, this experience precipitates distrustful relationships with care providers. The resulting impact on quality of care, staff morale, length of stay, and cost is high. The purpose of this article is to describe issues encountered by one medical center in caring for complex patients and families. A representative case outlines the types of issues the staff in the adult intensive care units faced. Use of a comprehensive problem-solving model to address concerns resulted in structured approaches to guide healthcare providers in caring for complex patients and families. The goal of these approaches was to support all parties involved in the care of complex patients, improve communication, and avoid crises that resulted from distrustful relationships and lack of skill in resolving conflict.

How healthcare professionals contribute to hope in patients with cancer.

PURPOSE/OBJECTIVES: To explore whether healthcare professionals influence the level of hope in patients with cancer and, if so, how they influence their hope. DESIGN: Descriptive, qualitative design. SETTING: An adult hematology/oncology unit in the upper midwestern United States. SAMPLE: Thirty-two men and women receiving active or supportive treatment or palliative care for cancer. METHODS: Semistructured interviews conducted in the participants' hospital rooms. Ten investigators and two consultants transcribed and analyzed the interview data using content analysis. They identified themes and subthemes that described healthcare professionals' roles. MAIN RESEARCH VARIABLES: Healthcare professionals' contributions to hope as described by patients with cancer. FINDINGS: Healthcare professionals positively and negatively influenced hope in this sample. Hope was facilitated by being present, giving information, and demonstrating caring behaviors. Negative influences on hope primarily concerned the way in which healthcare professionals gave information. CONCLUSION: Healthcare professionals do influence patients' perceptions of their hope. Although most nursing actions are hope enhancing, nurses can reduce a patient's sense of hope if information provided or attitude toward the patient is insensitive or disrespectful. IMPLICATIONS FOR NURSING PRACTICE: Nurses can increase patients' hope by being present, taking time to talk, and being helpful. They must provide information and answer questions in a compassionate, positive, honest, and respectful manner. Caring behaviors such as thoughtful gestures, showing warmth and genuineness, and being friendly and polite also increase patients' hope.

Creative models of spiritual care. As healthcare delivery changes, pastoral care departments must explore alternative staffing approaches.

Recognizing changes are coming to the healthcare delivery system, pastoral care departments are developing a new vision of spiritual care. As they educate and hire staff, many directors are finding that alternative staffing approaches can help them make the transition. Flexible schedules for pastoral care professionals improve the care they deliver and enhance morale. Restructuring responsibilities within the department and giving some patient populations priority can be helpful. Some facilities share chaplains' time to minimize on-call burden; others are increasingly using supervised volunteers. Pastoral care givers who are specialists in areas such as mental health and chemical dependency can often perform certain functions traditionally performed by other professionals. By assigning chaplains to a product or service line, pastoral care departments can improve the continuity of care patients receive. As parishes' role in the healing ministry takes on new meaning, healthcare institutions' pastoral care staff can help initiate and develop new parish services or provide assistance that complements existing parish efforts.

Responding to DRGs: ethical and mission implications.

Because of diagnosis related groups (DRGs), remaining financially solvent while being true to its mission is a bigger challenge than ever for the Catholic health facility. Tough decisions and judgments must be made, some of them unfamiliar. When does cost cutting compromise adequate care? Will Catholic hospitals be able to care for the "unprofitable" patient? To what extent will the profit motive damage patient trust? What will be the minimum level of care provided for all? Which programs and services can be dropped without sacrificing the Catholic mission? Hospitals should respond to DRGs in a number of ways: 1. Keep an appropriate balance between care values and cost values. 2. Continue to creatively provide care for the disenfranchised. 3. Critique inadequately brief or cheap care.

Nursing students' experience in critical care: implications for staff development.

The gap between preservice preparation of nurses for critical-care work and employers' expectations is a crucial factor in providing safe care in special-care units. In this study of senior nursing students from 32 Midwestern schools of nursing, it was found that about 75 per cent of the students had had some experience in critical care, with a mean of 46 hours of experience. Most students observed, did selected procedures, or helped a staff nurse. Only 3 per cent planned and carried out care for more than one patient at a time. Fifty-eight per cent considered themselves unprepared to work in areas of critical care and needed more practice and theoretical instruction. There was wide variation in adequacy of instruction in frequently-used assessment and management techniques.