Fostering positive emotions, psychological well-being, and productive relationships in the intensive care unit: A before-and-after study.

BACKGROUND: Intensive care units (ICUs) are emotionally demanding workplaces. Exposure to stress can negatively impact ICU staff members' emotional resilience, health, and capacity to provide care. Despite recognition of the benefits of promoting "healthy workplaces", there are limited interventional studies aimed at improving the well-being of ICU staff. AIM: The aim of this study was to assess the effectiveness of a multifaceted intervention for improving well-being of staff working in a tertiary ICU. METHODS: A before-and-after interventional study was conducted over a 2-year period, between 2019 and 2021. Interventions included social activities, fitness, nutrition, and emotional support. An electronic version of the PERMA-Profiler questionnaire was used to assess the well-being of a convenience sample of ICU staff before (n = 96) and after (n = 137) the intervention. Ten focus groups (each involving 12-18 nurses) were held to explore nurses' perceptions of the intervention's effectiveness. RESULTS: After the intervention, a significantly greater proportion of participants described their work week as draining (32% vs 19%, χ2 = 4.4 df + 1, P = 0.03) and at least a bit harder than normal (38% vs 22%, χ2 = 6.4 df + 1, p = 0.01) compared to baseline surveys. However, well-being scores after the intervention (mean = 6.95, standard deviation = 1.28) were not statistically different (p = 0.68) from baseline scores (mean = 7.02, standard deviation = 1.29). Analysis of focus groups data revealed three key categories: boosting morale and fostering togetherness, supporting staff, and barriers to well-being. CONCLUSIONS: After the intervention, there was a preserved level of well-being from baseline despite a statistically significant increase in staff reporting the work week as draining and at least a little bit harder than normal. These findings must be considered in light of the COVID-19 pandemic, which started after baseline data collection and continues to impact the community, including staff workload and pressures in intensive care. The study findings may inform strategies for improving ICU staff members' well-being.

Dying in intensive care: An analysis of the perspectives of families and clinicians on end-of-life care.

BACKGROUND: Despite a growing body of research into end-of-life care (EOLC) in intensive care units (ICUs), few studies have concurrently explored the perspectives of families and clinicians. OBJECTIVE: The objective of this study was to identify the characteristics of high-quality EOLC in the ICU from family and clinician perspectives and by examining the care documented in medical records. METHODS: A convergent mixed-methods study incorporating electronic health record audits (n = 20), structured interview surveys with families (n = 20), clinician surveys (n = 189), and focus groups (n = 10) was undertaken at a 30-bed, level 3 ICU at a metropolitan public adult teaching hospital in Australia. Descriptive statistics were calculated from quantitative data, and inductive thematic analysis was used to analyse qualitative data. RESULTS: Overall, families were very satisfied with EOLC and the quality of communication yet, felt that earlier, clearer communication that the patient was dying was required. Families spoke of the attentiveness, or lack thereof, by ICU clinicians and the opportunity to be present for the patient's death. The majority of ICU clinicians felt EOLC could be improved. Nurses highlighted communication challenges when family meetings were delayed. Some nurses expressed a lack of clarity of how to withdraw care, resulting in hesitancy to cease potentially inappropriate care, and to provide EOLC outside ICU practice norms. In many instances, observations, invasive monitoring, and interventions were documented after EOLC commenced. A lack of documented personal cares was also noted. CONCLUSIONS: This study provides new insights into EOLC from the dual perspectives of families and clinicians. There is a need for institutional guidelines to support ICU clinicians' EOLC practices and education to improve clinician confidence with communication.

Challenges to the development of a health care practice model for hospital social work in India.

India has a long history of delivering a western model of social work despite being challenged by unique structural challenges, as well as demographic and social changes impacting the types of presentations to hospitals. This paper reports on a project that explored the professional roles of Indian social workers in hospital settings, and documented some of the critical factors that impede capacity to meet the demands of a changing health care system. Extracted themes from participants identified a lack of role descriptions, professional supervision, and national standards as contributing to a lack of confidence in asserting strong professional identity and contribution to patient care.

The experiences of rural and remote families involved in an inter-hospital transfer to a tertiary ICU: a hermeneutic study.

BACKGROUND: Inter-hospital transfers are necessary for critically ill patients to improve their chance of survival. Rural and remote families experience significant disruption to family life when critically ill patients are required to undergo a transfer to a tertiary hospital. What is not known is how ICU staff can assist these families who are involved in an inter-hospital transfer to a tertiary ICU. PURPOSE: To gain an understanding of rural and remote critical care families' experiences during an inter-hospital transfer to a tertiary ICU. METHOD: A hermeneutic phenomenological approach was adopted informed by the philosophical world views of Heidegger and Gadamer. Data collection occurred by in-depth conversational interviews from a purposeful sample of seven family members. Interview transcripts, field notes and diary entries formed the text which underwent hermeneutic analysis. FINDINGS: Being confused, being engaged, being vulnerable and being resilient emerged as significant aspects of the rural and remote family members' experience during a transfer event. CONCLUSION: A better understanding of the experiences of rural and remote families during an inter-hospital transfer journey can inform the practice of ICU nurses. This study highlights the specific experiences of rural and remote families during an inter-hospital transfer journey to a tertiary ICU. It also informs nurses of the meaningful ways in which they can support these families with the uncertainty and chaos experienced as part of this journey.

The needs of families of trauma intensive care patients: A mixed methods study.

OBJECTIVE: To identify the needs of families of trauma patients in the Intensive Care Unit and to assess nurses' perceptions of those needs. METHODOLOGY: A sequential mixed-methods study was utilised combining survey data and semi-structured interviews. SETTING: A tertiary Intensive Care Unit in Australia. OUTCOME MEASURES: The Critical Care Family Needs Inventory assessed the needs of families of general and trauma patients. Nurses were also surveyed for their perspectives on the needs of trauma patients' families. Interviews with families were analysed using an inductive thematic analysis technique. RESULTS/FINDINGS: 214 surveys were completed (50 family members of trauma patients; 53 family members of general patients; 111 nurses). No statistically significant sub-scale differences in survey responses between the family groups were found. However, differences on four of the five survey sub-scales (p ≤ .001) were identified between families of trauma patients and nurses. Three themes emerged identifying unique needs of families of trauma patients from the interviews and included: Personal Distress and Adjustment,Guidance, and Care. CONCLUSION: This mixed methods study identified that families of trauma patients have different needs to families of general patients and the nurses rated the needs of the families of trauma patients as less important than the families rated their own needs. Through a collaborative partnership with these families, nurses can assist and better meet their needs. The provision of individualised patient/family-centred care is likely to have a positive influence.