Gunnlaugsdóttir Thora, Jónasdóttir Rannveig J, Björnsdóttir Kristín, Klinke Marianne Elisabeth
Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
Landspitali, The National University Hospital in Reykjavik, Iceland.
Int J Nurs Stud Adv. 2024 Oct 24;7:100251. doi: 10.1016/j.ijnsa.2024.100251. eCollection 2024 Dec.
Families are an important part of the intensive care unit (ICU) team. Being a family member in the ICU can be distressing due to interacting factors, such as the critical condition of the patient, the responsibility of acting as the patient's advocate, and partaking in decision-making related to treatment. Nurses need to be aware of the family's well-being throughout the patient's ICU stay.
To synthesize reviews of family members' experiences and needs during patients' ICU admission and develop recommendations to support nurses in strengthening their relationships with families.
Systematic review of qualitative and mixed method reviews.
Extensive searches without time limits identified systematic reviews published until June 27, 2024 in CINAHL, PubMed, Scopus, and Web of Science. Reviews were eligible if they provided knowledge required to inform high-quality on-site family care during the patient's ICU admission.
Quality appraisal adhered to the Joanna Briggs Institute checklist for systematic reviews and research syntheses. Themes were generated by integrating review results and narratively summarizing the main contents. Finally, findings were translated into clinical practice recommendations by using the four-component GRADE-CERQual assessment (low to high recommendation grades). Recommendations were backtracked to primary research studies for validation. All recommendations were critically reflected upon with an expert panel of ICU nurses.
The nine included reviews were built on 124 original studies published between 1995 and 2021. One central theme, "Emotional limbo and extreme moments", mirrored the core of families' experiences characterized by waiting time, i.e., for the patient to get better or worse, and overwhelming emotions and confusion brought about by the patient's critical illness. Three sub-themes reflected actions to counterbalance emotional challenges: a) Responding to family members' existential needs, b) Establishing optimal grounds for reciprocal communication, and c) Enhancing a humanizing approach and atmosphere in the ICU. The meta-synthesis resulted in 11 aggregated recommendations. The findings highlighted that nurses should proactively address emotional issues to help preserve families' ability to keep going, allow families to be present and function as a part of the team, and inform families of the patient's situation and how they can practically help.
Nurses should use multiple adjustable approaches to alleviate family's burden during an ICU stay. Findings help nurses to prioritize care and make physical and emotional space for family caregivers. Results emphasize the need to facilitate the agency of family caregivers and reinforce their strengths through nurse-family dialogues.
Novel recommendations to enhance nursing care of family members to patients admitted to the Intensive Care Unit.
家庭是重症监护病房（ICU）团队的重要组成部分。由于多种相互作用的因素，如患者的危急病情、充当患者代言人的责任以及参与治疗相关决策等，作为ICU患者的家属可能会感到痛苦。护士需要在患者入住ICU期间关注家属的身心健康。
综合回顾患者入住ICU期间家属的经历和需求，并提出建议以支持护士加强与家属的关系。
对定性和混合方法综述进行系统评价。
进行无时间限制的广泛检索，确定截至2024年6月27日在CINAHL、PubMed、Scopus和Web of Science上发表的系统评价。如果这些综述提供了患者入住ICU期间高质量现场家庭护理所需的知识，则符合纳入标准。
质量评估遵循乔安娜·布里格斯研究所系统评价和研究综合清单。通过整合综述结果并对主要内容进行叙述性总结来生成主题。最后，使用四成分GRADE-CERQual评估（推荐等级从低到高）将研究结果转化为临床实践建议。这些建议追溯至原始研究进行验证。所有建议都由ICU护士专家小组进行批判性反思。
纳入的9篇综述基于1995年至2021年发表的124项原始研究。一个中心主题“情感的不确定与极端时刻”反映了家属经历的核心，其特点是等待时间，即等待患者病情好转或恶化，以及患者危重病带来的压倒性情绪和困惑。三个子主题反映了应对情感挑战的行动：a）满足家属的生存需求，b）建立相互沟通的最佳基础，c）在ICU中增强人性化方法和氛围。综合分析得出11条汇总建议。研究结果强调，护士应积极解决情感问题，以帮助维持家属坚持下去的能力，允许家属在场并作为团队的一部分发挥作用，并告知家属患者的情况以及他们可以提供实际帮助的方式。
护士应采用多种可调整的方法减轻家属在患者入住ICU期间的负担。研究结果有助于护士确定护理重点，为家属照顾者留出身体和情感空间。结果强调需要促进家属照顾者的能动性，并通过护士与家属的对话增强他们的力量。
关于加强对入住重症监护病房患者家属护理的新建议。
