Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada.
Department of Critical Care Medicine, University of Calgary, Calgary, Canada.
J Crit Care. 2017 Dec;42:243-247. doi: 10.1016/j.jcrc.2017.08.008. Epub 2017 Aug 6.
To identify elements which enable patient and family centred care (PFCC) in the intensive care unit (ICU) and priorities for PFCC research.
We engaged a panel of multidisciplinary stakeholders in a modified Delphi process. Items generated from a literature review and panelist suggestions were rated in 3 successive rounds on a scale from 1 to 7. Median score was used to rate each item's priority, with 5 or more indicating "essential priority," 4 or 5 "moderate priority" and 3 or less "low priority." Interquartile range (IQR) was used to measure consensus, with IQR of 1 indicating "high" consensus, 2 "moderate" consensus, and 3 or greater "low" consensus.
Six items were rated essential elements for facilitating PFCC with high consensus (flexible visiting hours, family participation in bedside care, trained family support person, interventions to facilitate continuity of care, staff education to support families, continuity of staff assignments). Three items were rated essential research topics: interventions to facilitate continuity of care following ICU discharge (moderate consensus), family participation in bedside care (low consensus), and decision aids for end of life decision-making (low consensus).
Stakeholders identified clear and distinct priorities for PFCC in clinical care and research, though there was greater consensus for clinical care.
确定重症监护病房（ICU）中以患者和家属为中心的护理（PFCC）的要素和 PFCC 研究的重点。
我们邀请了一组多学科利益相关者参与改良 Delphi 流程。从文献综述和小组成员建议中生成的项目在 3 轮中按 1 到 7 的等级进行评分。中位数评分用于评估每个项目的优先级，得分为 5 或以上表示“高度优先”，4 或 5 表示“中度优先”，3 或以下表示“低度优先”。四分位距（IQR）用于衡量共识，IQR 为 1 表示“高度”共识，2 表示“中度”共识，3 或更高表示“低度”共识。
有 6 项被评为促进 PFCC 的基本要素，具有高度共识（灵活的探视时间、家属参与床边护理、受过培训的家庭支持人员、促进护理连续性的干预措施、支持家庭的员工教育、员工任务的连续性）。有 3 项被评为基本研究课题：促进 ICU 出院后护理连续性的干预措施（中度共识）、家属参与床边护理（低度共识）和生命终末期决策的决策辅助工具（低度共识）。
利益相关者确定了明确的以患者和家属为中心的护理在临床护理和研究中的重点，尽管在临床护理方面的共识更高。
