TY - JOUR
T1 - Actionable processes of care important to patients and family who experienced a prolonged intensive care unit stay
T2 - Qualitative interview study
AU - Rose, Louise
AU - Allum, Laura J.
AU - Istanboulian, Laura
AU - Dale, Craig
N1 - Funding Information:
This work was part of a larger research programme funded by the Michael Garron Hospital Community Based Research Fund; Ontario Respiratory Care Association; Canadian Lung Association and the European Society of Intensive Care Medicine. Laura Allum is funded by a National Institute for Health Research (NIHR) Clinical Doctoral Fellowship for this research project. The NIHR had no involvement in the preparation of the article, design or conduct of the research. The views expressed in this article do not communicate an official position of the NIHR.
Publisher Copyright:
© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
PY - 2021/10/27
Y1 - 2021/10/27
N2 - Aim: To use positive deviance to identify actionable processes of care that may improve outcomes and experience from the perspectives of prolonged intensive care unit (ICU) stay survivors and family members. Design: Prospective qualitative interview study in two geographically distant settings: Canada (2018/19) and the United Kingdom (2019/20). Methods: Patient and family participant inclusion criteria comprised: aged over 18 years, ICU stay in last 2 years of over 7 days, able to recall ICU stay and provided informed consent. We conducted semi-structured in-person or telephone interviews. Data were analysed using a positive deviance approach. Results: We recruited 29 participants (15 Canadian; 14 UK). Of these, 11 were survivors of prolonged ICU stay and 18 family members. We identified 22 actionable processes (16 common to Canadian and UK participants, 4 Canadian only and 2 UK only). We grouped processes under three themes: physical and functional recovery (nine processes), patient psychological well-being (seven processes) and family relations (six processes). Most commonly identified physical/functional processes were regular physiotherapy, and fundamental hygiene and elimination care. For patient psychological well-being: normalizing the environment and routines, and alleviating boredom and loneliness. For family relations: proactive communication, flexible family visiting and presence with facilities for family. Our positive deviance analysis approach revealed that incorporation of these actionable processes into clinical practice was the exception as opposed to the norm perceived driven by individual acts of kindness and empathy as opposed to standardized processes. Conclusion: Actionable processes of care important to prolonged ICU stay survivors and family members differ from those frequently used in ICU quality improvement (QI) tools. Impact: Our study emphasizes the need to develop QI tools that standardize delivery of actionable processes important to patients and families experiencing a prolonged ICU stay. As the largest healthcare professional group, nurses can play an essential role in leading this.
AB - Aim: To use positive deviance to identify actionable processes of care that may improve outcomes and experience from the perspectives of prolonged intensive care unit (ICU) stay survivors and family members. Design: Prospective qualitative interview study in two geographically distant settings: Canada (2018/19) and the United Kingdom (2019/20). Methods: Patient and family participant inclusion criteria comprised: aged over 18 years, ICU stay in last 2 years of over 7 days, able to recall ICU stay and provided informed consent. We conducted semi-structured in-person or telephone interviews. Data were analysed using a positive deviance approach. Results: We recruited 29 participants (15 Canadian; 14 UK). Of these, 11 were survivors of prolonged ICU stay and 18 family members. We identified 22 actionable processes (16 common to Canadian and UK participants, 4 Canadian only and 2 UK only). We grouped processes under three themes: physical and functional recovery (nine processes), patient psychological well-being (seven processes) and family relations (six processes). Most commonly identified physical/functional processes were regular physiotherapy, and fundamental hygiene and elimination care. For patient psychological well-being: normalizing the environment and routines, and alleviating boredom and loneliness. For family relations: proactive communication, flexible family visiting and presence with facilities for family. Our positive deviance analysis approach revealed that incorporation of these actionable processes into clinical practice was the exception as opposed to the norm perceived driven by individual acts of kindness and empathy as opposed to standardized processes. Conclusion: Actionable processes of care important to prolonged ICU stay survivors and family members differ from those frequently used in ICU quality improvement (QI) tools. Impact: Our study emphasizes the need to develop QI tools that standardize delivery of actionable processes important to patients and families experiencing a prolonged ICU stay. As the largest healthcare professional group, nurses can play an essential role in leading this.
KW - actionable processes
KW - chronic critical illness
KW - intensive care
KW - prolonged mechanical ventilation
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85118221718&partnerID=8YFLogxK
U2 - 10.1111/jan.15083
DO - 10.1111/jan.15083
M3 - Article
AN - SCOPUS:85118221718
SN - 0309-2402
JO - Journal of Advanced Nursing
JF - Journal of Advanced Nursing
ER -