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 Retrospective Study of Non-Ventilator-Associated Hospital Acquired Pneumonia Incidence and Missed Opportunities for Nursing Care.

OBJECTIVE: To determine non-ventilator-associated hospital-acquired pneumonia (NV-HAP) incidence, assess negative impacts on patient outcomes and cost, and identify missed preventive nursing care opportunities. BACKGROUND: NV-HAP is inadequately studied and underreported. Missed nursing care opportunities, particularly oral care, may aid NV-HAP prevention. METHODS: This descriptive, observational, retrospective chart review identified adult NV-HAP cases and associated demographic and hospital care data. RESULTS: Two hundred five NV-HAP cases occurred in 1 year at Montefiore Medical Center, equating to an incidence of 0.47 per 1000 patient-days and an estimated excess cost of $8.2 million. ICU transfer following pneumonia occurred in 15.6% of cases. Care requirements from specialist nursing facilities increased at discharge (26.8%), as compared with care requirements on admission (17.6%). Complete nursing care documentation was missing for most patients, with oral care undocumented 60.5% of the time. CONCLUSIONS: Preventable NV-HAP cases and their negative impact on cost and patient outcomes may decrease through improved basic nursing care.