The effects of foot reflexology on symptoms of discomfort in palliative care: a feasibility study.

BACKGROUND: In palliative care, the relief of discomfort is sought by an overall approach, combining prescribed medication and additional therapies, such as foot reflexology (FR). The main objective of this study was to assess the feasibility of FR in a population of inpatients in a palliative care unit (PCU).The precariousness of the patients led us to perform a feasibility study and not a cohort study from the outset. Its secondary objective was to assess the impact of an FR session on some symptoms of discomfort (anxiety, pain, troubled sleep, and psychological distress). METHODS: This is a feasibility study designed as a randomized controlled two-arm therapeutic trial. One arm tested FR, the other an active control, massage therapy (MT). The evaluators were blinded. RESULTS: FR was feasible for 14 patients out of the 15 included in the FR group (95% CI [68%; 100%]). These patients were in the palliative care phase of cancer, motor neuron disease, or terminal organ failure. Concerning the symptoms of discomfort, ESAS sleep quality score was on average 3.9 (± 2.5) before a session in the FR group. It was improved to an average of 3 (± 2.3) on the day after the session (effect-size = 0.38 [0.03; 0.73]). CONCLUSION: This study confirms the feasibility of an FR session for patients hospitalized in a PCU. It resulted in a slight improvement in sleep quality. For other discomfort symptoms such as anxiety, pain and distress, FR yielded a non-significant improvement. Significant results would have needed a larger cohort.

Survey of caregiver opinions on the practicalities of family-centred care in intensive care units.

AIMS AND OBJECTIVES: To determine caregiver opinion on their intensive care unit's policies with regard to visiting hours, how families are informed and participate in patient care. BACKGROUND: Benefits of improving family access to the intensive care unit, information delivery and participation of families in care have been suggested. DESIGN: Survey of caregivers working in French-speaking intensive care units. METHODS: An e-mail invitation to complete an online, closed-ended questionnaire was issued to caregivers registered in the mailing list of the French society of intensive care. RESULTS: Caregivers (n = 731) working in 222 adult and 41 paediatric intensive care units completed the questionnaire. Unlike in paediatric intensive care units, 58% of adult intensive care unit had restricted visiting hours (< 4 hour). However, 63% of respondents would recommend extended visiting periods. A 24-hour policy existed in 7% of adult intensive care units; 10% of respondents from these intensive care units thought reducing visiting periods would be very useful or essential; 81% thought that a 24-hour policy contributed to improved relations with families; and only 9% thought that it was a hindrance to care. Over 90% of caregivers thought that families should be informed of patient progress in a designated room in the presence of the patient's nurse and that patient records should report family meetings. This policy was only implemented in half of the cases. Family participation in care procedures was strongly encouraged in only 0·5% of adult intensive care units. CONCLUSIONS: Intensive care unit caregivers are in favour of longer visiting hours, increased use of designated rooms for, and nurse participation in, meetings with families. Although caregivers do not associate families with care procedures, they considered that their presence during most interventions should be authorised. RELEVANCE TO CLINICAL PRACTICE: Our results could help in implementing intensive care unit policies concerning visiting hours, how families are informed and participate in patient care.

How caregivers view patient comfort and what they do to improve it: a French survey.

BACKGROUND: Intensive care unit (ICU) patients are exposed to many sources of discomfort. Most of these are related to the patient's condition, but ICU design or how care is organized also can contribute. The present survey was designed to describe the opinions of ICU caregivers on sources of patient discomfort and to determine how they were dealt with in practice. The architectural and organizational characteristics of ICUs also were analyzed in relation to patient comfort. METHODS: An online, closed-ended questionnaire was developed. ICU caregivers registered at the French society of intensive care were invited to complete this questionnaire. RESULTS: A total of 915 staff members (55% nurses) from 264 adult and 28 pediatric ICUs completed the questionnaire. Analysis of the answers reveals that: 68% of ICUs had only single-occupancy rooms, and 66% had natural light in each room; ICU patients had access to television in 59% of ICUs; a clock was present in each room in 68% of ICUs. Visiting times were <4 h in 49% of adult ICUs, whereas 64% of respondents considered a 24-h policy to be very useful or essential to patients' well-being. A nurse-driven analgesia protocol was available in 42% of units. For caregivers, the main sources of patient discomfort were anxiety, feelings of restraint, noise, and sleep disturbances. Paramedics generally considered discomfort related to thirst, lack of privacy, and the lack of space and time references, whereas almost 50% of doctors ignored these sources of discomfort. Half of caregivers indicated they assessed sleep quality. A minority of caregivers declared regular use of noise-reduction strategies. Twenty percent of respondents admitted to having non-work-related conversations during patient care, and only 40% indicated that care often was or always was provided without closing doors. Family participation in care was planned in very few adult ICUs. CONCLUSIONS: Results of this survey showed that ICUs are poorly equipped to ensure patient privacy and rest. Access by loved ones and their participation in care also is limited. The data also highlighted that some sources of discomfort are less often taken into account by caregivers, despite being considered to contribute significantly.