Istanboulian Laura, Rose Louise, Yunusova Yana, Dale Craig
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Provincial Prolonged-Ventilation Weaning Centre for Excellence and Long-Term Ventilation, Michael Garron Hospital, Toronto, Ontario, Canada.
Nurs Crit Care. 2023 Nov;28(6):1069-1077. doi: 10.1111/nicc.12828. Epub 2022 Jul 25.
Although bundled communication interventions are recommended to address communication barriers for patients with an advanced airway in the intensive care unit (ICU) such interventions have not been evaluated in pandemic conditions.
To evaluate the acceptability, appropriateness, and feasibility of a co-designed bundled intervention to support communication with adult patients with an advanced airway in ICU in pandemic conditions.
Prospective, convergent mixed method design in a single centre medical-surgical ICU in Toronto, Canada between September 2021-March 2022. After the use of the co-designed bundled communication intervention quantitative data were collected from health care providers using validated acceptability, appropriateness, and feasibility measures and analysed using descriptive statistics. Qualitative data were collected from providers, patients and families using semi-structured interviews and analysed using content analysis applying the theoretical framework of acceptability. Joint table analysis enabled the integration of the two data sets.
A total of 64 (41.3%) HCPs responded to the survey: 54 (84.4%) rated the intervention acceptable; 55 (85.9%) appropriate; and 49 (76.6%) feasible for use in this context. Qualitative data (23 interviews: 13 healthcare providers, 6 families and 4 patients) and the joint table analysis extended the understanding that intervention acceptability was related to positive affective attitudes and reduced communication frustration. Appropriateness and feasibility were promoted through intervention alignment with values, ability to personalize tools, and ease of access. Recommendations to improve the acceptability included adaptation for immobilized and/or restrained patients, additional education, and integration into existing workflows.
This mixed method evaluation of a co-designed bundled intervention to support patient communication in the ICU during pandemic conditions demonstrated high rated and described acceptability, appropriateness, and feasibility by participants.
A co-designed communication intervention demonstrating stakeholder acceptability, appropriateness, and feasibility can be implemented into clinical practice in pandemic and other infection prevention and control contexts.
尽管推荐采用综合沟通干预措施来解决重症监护病房（ICU）中气道管理患者的沟通障碍，但此类干预措施尚未在大流行情况下进行评估。
评估一项共同设计的综合干预措施在大流行情况下支持加拿大安大略省多伦多一家单中心内科-外科ICU成年气道管理患者沟通的可接受性、适宜性和可行性。
2021年9月至2022年3月在加拿大安大略省多伦多一家单中心内科-外科ICU进行前瞻性、收敛性混合方法设计。在使用共同设计的综合沟通干预措施后，使用经过验证的可接受性、适宜性和可行性指标从医疗保健提供者处收集定量数据，并使用描述性统计进行分析。使用半结构化访谈从提供者、患者和家属处收集定性数据，并使用应用可接受性理论框架的内容分析进行分析。联合表格分析实现了两个数据集的整合。
共有64名（41.3%）医护人员回复了调查：54名（84.4%）认为该干预措施可接受；55名（85.9%）认为适宜；49名（76.6%）认为在此情况下可行。定性数据（23次访谈：13名医护人员、6名家属和4名患者）和联合表格分析进一步表明，干预措施的可接受性与积极的情感态度和减少的沟通挫折感有关。通过使干预措施与价值观保持一致、工具个性化的能力以及易于获取，提高了适宜性和可行性。提高可接受性的建议包括针对固定和/或约束患者进行调整、增加教育以及融入现有工作流程。
这项对共同设计的综合干预措施在大流行情况下支持ICU患者沟通的混合方法评估显示，参与者对该措施的评价很高，并描述了其可接受性、适宜性和可行性。
一项展示了利益相关者可接受性、适宜性和可行性的共同设计沟通干预措施可在大流行及其他感染预防和控制环境中实施到临床实践中。
