Li Baiyu, Yang Qin
Department of Comprehensive Intensive Care Unit, Affiliated Hospital of Yangzhou University, Yangzhou First People's Hospital, Yangzhou, Jiangsu, China.
Nursing College of Yangzhou University, Yangzhou, Jiangsu, China.
Nurs Crit Care. 2023 May;28(3):435-445. doi: 10.1111/nicc.12764. Epub 2022 Apr 9.
ICUs follow a restrictive companionship policy, especially after the COVID-19 outbreak. This strategy often limits the time families spend with patients, hinders their knowledge and skills in caregiving, and the sudden transfer of ICU patients to assist with disease monitoring and daily care can be very stressful for families. It is beneficial to use the transition period of transferring ICU patients to help families adjust to the role of caregiver.
To develop and implement a patient- and family-centered transitional care intervention plan for patients transferred to the ICU.
Prospective, pretest and posttest design.
The experimental group received an individualized family-centered transition plan led by the ICU liaison nurse that included 1) communication with health care professionals; distribution of a transfer booklet; 2) identification of nursing issues and communication with the ward nurse; invitation of family members to participate in the patient's rehabilitation; 3) follow-up instruction on bedside range of motion exercises; and provision of a patient rehabilitation diary. Patients in the control group received only routine care. Data were collected using the General Information Questionnaire, Family Satisfaction with ICU Patients (FS-ICU), the Family Relocation Stress Scale (FRSS), and the Stanford Acute Stress Response Questionnaire (SASRQR).
After the intervention, the total family satisfaction score of ICU patients in the experimental group was significantly higher than that of the control group (87.18 ± 8.38 vs 78.74 ± 10.63, p<0.001), and the satisfaction with the care and information provided was significantly higher in the experimental group compared to the control group (p < 0.001), with no significant difference between the two groups in terms of satisfaction with decision making (p>0.001). The level of relocation stress of patients' families was significantly lower in the experimental group compared to the control group after the intervention (p < 0.001). And there was no statistically significant difference between the two groups in terms of patients' acute stress disorder scores (p>0.001).
The implementation of a family-involved transition care programme significantly improved the satisfaction of ICU patients' families and reduced the stress of relocation for patients' families.
Focusing on the transition of ICU patients to ensure continuity of critical care and improve the quality of care for ICU patient transfers can be accomplished through a family-centered transition care plan led by the ICU liaison nurse.
重症监护病房(ICU)遵循严格的陪伴政策,尤其是在新冠疫情爆发之后。这种策略常常限制了家属陪伴患者的时间,阻碍了他们的护理知识和技能,而且将ICU患者突然转出以协助疾病监测和日常护理,对家属来说可能压力极大。利用将ICU患者转出的过渡期来帮助家属适应护理者角色是有益的。
为转入ICU的患者制定并实施以患者和家庭为中心的过渡性护理干预计划。
前瞻性、前后测设计。
实验组接受由ICU联络护士主导的个性化家庭中心过渡计划,包括1)与医护人员沟通;发放转科手册;2)确定护理问题并与病房护士沟通;邀请家属参与患者康复;3)对床边关节活动度练习进行随访指导;提供患者康复日记。对照组患者仅接受常规护理。使用一般信息问卷、ICU患者家属满意度(FS-ICU)、家庭转科应激量表(FRSS)和斯坦福急性应激反应问卷(SASRQR)收集数据。
干预后,实验组ICU患者家属的总体满意度得分显著高于对照组(87.18±8.38对78.74±10.63,p<0.001),与对照组相比,实验组对所提供护理和信息的满意度显著更高(p<0.001),两组在决策满意度方面无显著差异(p>0.001)。干预后,实验组患者家属的转科应激水平显著低于对照组(p<0.001)。两组患者的急性应激障碍得分无统计学显著差异(p>0.001)。
实施家属参与的过渡性护理计划显著提高了ICU患者家属的满意度,并减轻了患者家属的转科压力。
关注ICU患者的转科,以确保重症护理的连续性并提高ICU患者转科的护理质量,可以通过由ICU联络护士主导的以家庭为中心的过渡性护理计划来实现。