School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, 9 Sighthill Court, EH11 4BN Edinburgh, UK.
School of Medicine, Centre for Applied Health Economics, Griffith University, Nathan campus, N16 -1.10K, QLD 4111, Australia.
Int J Nurs Stud. 2021 Jan;113:103771. doi: 10.1016/j.ijnurstu.2020.103771. Epub 2020 Sep 8.
The involvement of family members in the ward rounds is a novel but under-researched family-centered care intervention in adult intensive care units, with limited evidence on the impact it has on patient and family-centered outcomes.
This integrative review aimed to understand how family rounds are implemented in critical care and to appraise the evidence on outcomes for patients, family members, and healthcare professionals.
An integrative review methodological framework permitted the inclusion of all research designs.
MEDLINE; CINAHL; PsycINFO; Cochrane Library; Web of Science Current Contents Connect; Web of Science-Core Collection; The Joanna Briggs Institute EBP Database; ProQuest Sociological Abstracts; and ProQuest Dissertation and Theses Global, Embase were systematically searched.
We reviewed studies that referred to or used as an intervention the involvement of family members in daily critical care team rounds. We included primary research in adult intensive care units regardless of patients' length of stay. We excluded patients receiving end-of-life care. We considered any outcome related to the critically ill patient and/or their family member, outcomes related to the healthcare professionals, and outcomes related to clinical and/or nursing treatment. The Mixed Methods Appraisal Tool was used to appraise the quality of the studies. The review was registered in the Prospero database.
From the 541 articles initially retrieved, 15 studies met the inclusion criteria and were included in the review. Studies originated from the United States of America and Canada since 2003, and a variety of designs were used. Four before and after studies and a non-randomized experimental study explored the impact of structured family rounds on family and staff satisfaction, showing limited improvement in satisfaction. Six cross-sectional survey studies explored family members' and clinicians' perceptions and demonstrated a positive attitude towards family-centered rounds, but some concerns were raised from the nursing staff. Three qualitative studies and a mixed-methods study identified structural and cultural factors influencing healthcare professionals' and families' acceptance of family rounds. Most studies were of poor to moderate quality, with limited confidence in the outcomes reported.
Most studies reported improved family satisfaction as the main outcome. Future research should focus on longitudinal patient and family-centered outcomes, including mental health outcomes, and on qualitative data to understand the processes, barriers, and facilitators to implement family-centered rounds in intensive care units.
在成人重症监护病房中，让家庭成员参与病房查房是一种新颖但研究不足的以家庭为中心的护理干预措施，关于其对患者和以家庭为中心的结果的影响，证据有限。
本综合评价旨在了解重症监护中如何实施家庭查房，并评价患者、家庭成员和医疗保健专业人员的结果证据。
综合评价方法框架允许纳入所有研究设计。
MEDLINE；CINAHL；PsycINFO；Cochrane 图书馆；Web of Science 当前内容连接；Web of Science-Core Collection； Joanna Briggs 研究所 EBP 数据库；ProQuest 社会学摘要；ProQuest 论文和论文全球，Embase 进行了系统搜索。
我们审查了提到或使用家庭成员参与日常重症护理团队查房作为干预措施的研究。我们纳入了成年重症监护病房的主要研究，无论患者的住院时间长短。我们排除了接受临终关怀的患者。我们考虑了与危重症患者及其家庭成员相关的任何结果、与医疗保健专业人员相关的结果、与临床和/或护理治疗相关的结果。使用混合方法评估工具评估研究的质量。该审查已在 Prospero 数据库中注册。
从最初检索到的 541 篇文章中，有 15 篇研究符合纳入标准并纳入了本综述。研究起源于 2003 年以来的美国和加拿大，使用了各种设计。四项前后研究和一项非随机实验研究探讨了结构化家庭查房对家庭和工作人员满意度的影响，显示满意度仅略有改善。六项横断面调查研究探讨了家庭成员和临床医生的看法，并表明对以家庭为中心的查房持积极态度，但护理人员提出了一些担忧。三项定性研究和一项混合方法研究确定了影响医疗保健专业人员和家庭接受家庭查房的结构和文化因素。大多数研究的质量较差或中等，对报告的结果的可信度有限。
大多数研究报告主要结果为家庭满意度提高。未来的研究应侧重于患者和以家庭为中心的纵向结果，包括心理健康结果，并侧重于定性数据，以了解在重症监护病房实施以家庭为中心的查房的过程、障碍和促进因素。
