Engagement of families in ICU from the nursing staff perspective

Background: Family engagement in intensive care units (ICU) is proposed as a way to increase active partnership with patients and move away from paternalism (Burns et al 2018). Family engagement and family-centred care are closely linked to improve the quality of care. The term and practice of ‘family engagement’ is complex but Burns et al (2018) viewed patient and family engagement as a way to achieve family centred care. Promoting family engagement within the ICU setting is recognised as more challenging to nursing practice because of the added emotional aspects for families of acutely ill patients (Brown et al 2015). This research was part of an international collaboration supported by the Family Care in Acute and Critical Illness Research Cluster which is supported by the International Family Nursing Association. This presentation will focus on the findings of the UK aspect of the research. Research Question: How do nurses from one English setting describe their nursing engagement with families of adults admitted in intensive care units? Methods: A social ecological approach (Bronfenbrenner, 1979) was used for this study. Social ecology acknowledges that families are complex groups that interact with other people and their world to provide meaning. Data were collected including demographic information, individual semi-structured qualitative interviews which were transcribed, and a questionnaire ‘Factors That Influence Family Engagement (QFIFE)’ (Hetland, Hickman, McAndrew, & Daly, 2017). One intensive care unit in the South East of England was used for this study. Permanent members of the nursing team were invited to participate. Analysis was undertaken using a statistic package (SPSS version 21) for questionnaire data and a content analysis approach for qualitative data. Ethical approval was gained from the University and Gray Area Project approval from the healthcare organisation. Results: Seven participants completed all aspects of the data collection. All participants rated that family engagement was important. Engagement varied depending of the acuity of the patient with nurses deciding the level of family engagement at a particular point in the patient journey. As the patients’ illness stabilised the involvement of the family was promoted. The family engagement role can be described as observers, encouragers, supporter or active participants in patient care. Staff were particularly concerned about maintaining the safety of the patient during any family activities and developing good communication. Initial analysis suggests that nurses regulate family engagement to ensure safety of patients and to promote recovery. Families need encouragement from ICU nurses to engage in a meaningful way. Building rapport and setting boundaries are skills needed by nurses and families value explanation of care. Conclusions: Family engagement needs careful consideration about the amount and type of activities that are appropriate and safe for families to undertake at a particular point. However, family engagement is seen as positive contribution to the patient recovery journey. This international project will continue to compare and combine results across the world. Consideration of future initiatives to family engagement in ICU will be further outlined

Validation of the Simplified Motor Score in patients with traumatic brain injury at a major trauma centre in South Africa

Background. This study used data from a large prospectively entered database to assess the efficacy of the motor score (M score) component of the Glasgow Coma Scale (GCS) and the Simplified Motor Score (SMS) in predicting overall outcome in patients with traumatic brain injury (TBI).Objective. To safely and reliably simplify the scoring system used to assess level of consciousness of trauma patients in the acute setting.Methods. A retrospective observational review of the Pietermaritzburg Metropolitan Trauma Service hybrid electronic medical registry database was performed during the period January 2013 - December 2015. Patients were classified into three groups using their GCS as an injury severity score. These were mild TBI (GCS 13 - 15), moderate TBI (GCS 9 - 12) and severe TBI (GCS <9). The Glasgow M score was specifically evaluated to determine the relationship between the individual motor component and patient outcome.Results. GCS scores and M scores were analysed in a total of 830 patients. There was a decline in survival rate when the M score on admission was ≤4. The decline was more significant when the M score was ≤3. Survival rates were 26.8% (11/41) for patients with an M score of 1, 63.6% (14/22) for those with a score of 2, 56.5% (13/23) for those with a score of 3, 80.0% (20/25) for those with a score of 4, and 95.5% (121/128) for those with a score of 5. Of 591 patients with an M score of 6, 580 (98.1%) survived. Mortality rose dramatically with declining SMS. This was highly significant. When the M score was plotted against mortality in 830 patients, there was a correct prediction in 769 cases (accuracy 92.7%, sensitivity 67.6%, specificity 95%). The area under the receiver operating characteristic (ROC) curve was 0.9037, with a standard deviation (area) of 0.0227. When comparing the SMS against mortality, the accuracy was 77.1%, the sensitivity 84.5% and the specificity 76.4%. The fitted ROC area was 0.891 and the empirical ROC area 0.86.Conclusion. The M score component of the GCS and the SMS accurately predict outcome in patients with TBI. In cases where the full GCS is difficult to assess, the M score and SMS can be used safely as a triage tool

Intensive care nurse-family engagement from a global perspective: A qualitative multi-site exploration

Background: Critical illness is distressing for families, and often results in negative effects on family health that influence a family\u27s ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. Objectives: To describe nurses’ perceptions and practices of family engagement in adult intensive care units from a global perspective. Design: A qualitative-descriptive multi-site design using content analysis. Settings: The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. Participants: A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. Methods: Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. Results: We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses’ practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses’ attitudes and perceptions of family, the patient\u27s condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses’ ability to engage with families. Conclusions: This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care

Validation of the Simplified Motor Score in patients with traumatic brain injury at a major trauma centre in South Africa

Background. This study used data from a large prospectively entered database to assess the efficacy of the motor score (M score) component of the Glasgow Coma Scale (GCS) and the Simplified Motor Score (SMS) in predicting overall outcome in patients with traumatic brain injury (TBI).Objective. To safely and reliably simplify the scoring system used to assess level of consciousness of trauma patients in the acute setting.Methods. A retrospective observational review of the Pietermaritzburg Metropolitan Trauma Service hybrid electronic medical registry database was performed during the period January 2013 - December 2015. Patients were classified into three groups using their GCS as an injury severity score. These were mild TBI (GCS 13 - 15), moderate TBI (GCS 9 - 12) and severe TBI (GCS <9). The Glasgow M score was specifically evaluated to determine the relationship between the individual motor component and patient outcome.Results. GCS scores and M scores were analysed in a total of 830 patients. There was a decline in survival rate when the M score on admission was ≤4. The decline was more significant when the M score was ≤3. Survival rates were 26.8% (11/41) for patients with an M score of 1, 63.6% (14/22) for those with a score of 2, 56.5% (13/23) for those with a score of 3, 80.0% (20/25) for those with a score of 4, and 95.5% (121/128) for those with a score of 5. Of 591 patients with an M score of 6, 580 (98.1%) survived. Mortality rose dramatically with declining SMS. This was highly significant. When the M score was plotted against mortality in 830 patients, there was a correct prediction in 769 cases (accuracy 92.7%, sensitivity 67.6%, specificity 95%). The area under the receiver operating characteristic (ROC) curve was 0.9037, with a standard deviation (area) of 0.0227. When comparing the SMS against mortality, the accuracy was 77.1%, the sensitivity 84.5% and the specificity 76.4%. The fitted ROC area was 0.891 and the empirical ROC area 0.86.Conclusion. The M score component of the GCS and the SMS accurately predict outcome in patients with TBI. In cases where the full GCS is difficult to assess, the M score and SMS can be used safely as a triage tool.

An analysis of adverse events and human error associated with the imaging of patients at a major trauma centre in South Africa

Background. There is growing realisation that human error contributes significantly to morbidity and mortality in modern healthcare. A number of taxonomies and classification systems have been developed in an attempt to categorise errors and quantify their impact.Objectives. To record and identify adverse events and errors as they impacted on acute trauma patients undergoing a computed tomography (CT) scan, and then quantify the effect this had on the individual patients. It is hoped that these data will provide evidence to develop error prevention programmes designed to reduce the incidence of human error.Methods. The trauma database was interrogated for the period December 2012 - April 2017. All patients aged >18 years who underwent a CT scan for blunt trauma were included. All recorded morbidity for these patients was reviewed.Results. During the period under review, a total of 1 566 patients required a CT scan at our institution following blunt trauma. Of these, 192 (12.3%, 134 male and 58 female) experienced an error related to the process of undergoing a CT scan. Of 755 patients who underwent a CT scan with intravenous contrast, detailed results were available for 312, and of these 46 (14.7%) had an acute deterioration in renal function. According to Chang’s taxonomy, physical harm occurred as follows: grade I n=6, grade II n=62, grade III n=45, grade IV n=11, grade V n=27, grade VI n=21, grade VII n=15, grade VIII n=3 and grade IX n=2. Adverse events were performing an unnecessary scan (n=24), omitting an indicated scan (n=23), performing the scan incorrectly (n=8), scanning the wrong body part (n=7), equipment failure (n=18), omitting treatment following the scan (n=6), incorrect interpretation of the scan (n=65), deterioration during the scan (n=6) and others (n=35). The setting for the error was the ward (n=19), the radiology suite (n=126), the emergency department (n=45) and the operating theatre (n=2). The staff responsible for the adverse events were medical (n=155), nursing (n=4) and radiology staff (n=15). There were 67 errors of commission and 125 errors of omission. The primary cause was a planning problem in 78 cases and an execution problem in 114.Conclusions. Errors and adverse events related to obtaining a CT scan following blunt polytrauma are not uncommon and may impact significantly on the patient. Communication is essential to eliminate errors related to performing the wrong type of scan. The commonest errors relate to misinterpretation of the scan

An attempt at using selected amphibian populations to assess quality of soil-water environment in agricultural areas

Wśród organizmów bytujących w środowisku gruntowo-wodnym, bardzo wrażliwą na zmiany jakości wody grupę zwierząt stanowią płazy. Te ważne bioindykatory środowiska gruntowo-wodnego należą do kręgowców najbardziej zagrożonych wyginięciem. W związku z tym podjęto próbę oceny stanu populacji płazów na wybranym obszarze użytkowanym rolniczo, analizując jakość wód powierzchniowych w zbiornikach będących ich siedliskami, a także wód gruntowych z sąsiednich terenów rolnych. Biomonitoring jakości środowiska gruntowo-wodnego obejmował dwa siedliska płazów na obszarach gminy Stare Czarnowo (woj. zachodniopomorskie, Polska). Przeprowadzone analizy składu wód powierzchniowych i wód gruntowych wykazały dobry stan jakości siedlisk płazów, co potwierdziło liczne występowanie tych zwierząt. W obu siedliskach dominowały żaby zielone (P. lessonae/P. esculentus) i żaby brunatne (R. arvalis). Współczynnik podobieństwa Jaccarda wykazał zróżnicowanie badanych siedlisk, a ocena wskaźnika dogodności siedliska (HSI) dowiodła, że tylko jedno siedlisko stwarzało odpowiednie warunki do bytowania płazów. Wykazano, że nie tylko jakość wód miała znaczenie w doborze siedliska płazów, ale również inne elementy środowiskowe. Powinno to skłaniać do prowadzenia stałego biomonitoringu płazów w Polsce, ponieważ wiedza na temat ich rozmieszczenia nie jest wystarczająca.Amphibians as a group are very sensitive to water quality changes among organisms inhabiting soil-water environment. Those important bioindicators of soil-water environmemt are among the most endangered vertebrates. Therefore, an attempt was made to assess amphibian population status in the selected agricultural area. It was performed by analyzing surface water quality in the amphibian pond habitats as well as groundwater from the neighboring agricultural land. Biomonitoring of the soil-water environment quality included two selected amphibian habitats in the area of Gmina Stare Czarnowo (West Pomeranian Voivodeship, Poland). Content analyses of the surface and groundwaters demon-strated a good quality of amphibian habitats, confirmed by numerous amphibian occurrence. Both habitats wered dominated by green frogs (P. lessonae/P. esculentus) and brown frogs (R. arvalis). Jaccard similarity coefficient showed diversity of habitats investigated and Habitat Suitability Index (HSI) proved that only S1 was an appropriate habitat for amphibians. It was demonstrated that not only played water quality a role in amphibian habitat selection, but other environmental factors were important as well. Constant biomonitoring of amphibians in Poland would be recommended as knowledge about their distribution is still not adequate

Wpływ aeratora pulweryzacyjnego na zmiany stężenia tlenu i związków azotu w wodzie jeziora Starzyc

Due to poor ecological status of Lake Starzyc, lake restoration measures were undertaken in 2003 to improve aerobic conditions of near-bottom waters and to decrease phosphorus concentrations. To do this, a winddriven pulverising aerator was installed in the lake. The aim of this study was to analyse variability of oxygen and nitrogen concentrations in lake water near the aerator in the third year of its operation and later on in the three-year-long period of the years 2008–2010. It was found that concentrations of ammonium-nitrogen, nitratenitrogen and dissolved oxygen near the aerator did not differ from those in sites 4 and 5, which evidenced similar abiotic conditions in analysed waters. Higher concentrations of dissolved oxygen and lower concentrations of nitrate-nitrogen were found in the years 2008–2010 than in 2005.Ze względu na słaby stan ekologiczny jeziora Starzyc podjęto w 2003 r. działania rekultywacyjne, których celem była poprawa stanu natlenienia wód przydennych i obniżenie koncentracji związków fosforu. W tym celu zainstalowano na jeziorze aerator pulweryzacyjny z napędem wietrznym. Celem pracy była analiza zmienności stężenia tlenu i związków azotu w wodzie jeziora Starzyc w sąsiedztwie aeratora pulweryzacyjnego w trzecim roku jego działania (2005) oraz w kolejnych latach w trzyletnim okresie (2008–2010). Ustalono, że stężenie azotu amonowego i azotanowego (V) oraz tlenu rozpuszczonego w wodzie w punkcie w pobliżu aeratora nie różniło się od wartości pomiarów tych wskaźników w punktach 4 i 5, co świadczy o zbliżonych warunkach abiotycznych charakteryzujących badane wody. Stwierdzono większe stężenie tlenu rozpuszczonego w wodzie, a mniejsze stężenie azotu azotanowego (V) w latach 2008–2010 w porównaniu z 2005 r

Characteristics of the macro - and microelements in benthic sediments of selected mid-field ponds

The agricultural landscape of Western Pomerania is characterised by frequent occurrence of small, post-glacial water ponds commonly called mid-field ponds. They serve numerous important functions, both with regard to agriculture and ecology. Due to their specific location in the agricultural landscape, they are exposed to permanent and strong anthropic pressure, which often translates into pollution of surface water and benthic sediments with macro-and microelements. This study attempts to assess and determine the level of macro – and microelements in benthic sediments, depending on the type of agricultural production, on the example of selected mid-field ponds. The assessed benthic sediments of both ponds were characterised by varied macro - and microelement levels, depending on the collection site and the depth of their deposition. Based on the performed chemical analyses it was found that both observation points in the pond Żelisławiec were characterised by the highest concentrations occurring in the top layer (0-5 cm), which is related to the fact that there are areas of agriculture in the pond basin with the use of mineral and organic fertilisation and occurrence of higher water erosion. And the other assessed mid-field pond (Stare Czarnowo) showed the highest concentration of microelements in the middle layer, 5-15 cm. Statistical analyses revealed that statistically significant differences were observed only for potassium levels, depending on the type of agricultural production in the basin of both assessed ponds. This may result from various types of agricultural crops (Brassica napus L. var. napus and ×Triticosecale Wittm. ex A.Camus) and intense fertilization of arable land in Stare Czarnowo. Statistically significant differences in particular layers of sediment confirm that depending on the type of agricultural activity, mid-field ponds are supplied with various mineral matter at different times, resulting in its accumulation in benthic sediments

Possibilities of recreational fishing use of small mid-field water reservoirs on the background of environmental conditions

W artykule przedstawiono podstawowe parametry określające presję połowową na 8 niewielkich zbiornikach wodnych na terenach rolniczych w województwie zachodniopomorskim. Oceniono warunki siedliskowe ryb i zróżnicowanie chemiczne wód w poszczególnych zbiornikach. Przedstawiono ichtiofaunę złowioną przez wędkarzy w każdym akwenie, określono współczynnik stałości występowania (Ci) i dominacji (Di) gatunków. Badania hydrochemiczne nie wykazały podwyższonego poziomu biogenów w badanych zbiornikach wodnych w porównaniu z akwenami o większej powierzchni. Łącznie ze wszystkich 8 zbiorników w dwuletnim cyklu badawczym odłowiono 501 ryb należących do 9 gatunków. Wśród złowionych ryb zanotowano największą liczbę karasi pospolitych (Carassius carassius L.), których łącznie w okresie dwóch lat badań złowiono 127 szt. Nieco mniej odłowiono okoni (Perca fluviatilis L.) i płoci (Rutilus rutilus L.) – w obu przypadkach po 92 osobniki. Największą wartość współczynnika dominacji odnotowano w odniesieniu do karasia pospolitego (25,25%), a najmniejszy – jazia (Leuciscus idus L.) (0,20%). Również największe wartości współczynnika stałości występowania (Ci) stwierdzono w przypadku karasia pospolitego (87,5%) i nieznacznie niższy – lina (Tinca tinca L.) (75,0%). W dwuletnim cyklu prowadzonych badań rozdano 99 ankiet wędkarskich, a zbiornikiem wodnym, na którym poławiało najwięcej wędkarzy, był ZW1 (35 wędkarzy).The article presents the basic parameters determining the fishing pressure on 8 ponds located on agricultural areas in West Pomeranian Region. The habitat conditions of fishes were assessed and the hydrochemical differentiation of individual ponds was given. The ichthyofauna caught by anglers in each ponds was presented, coefficient of occurrence (Ci) and dominance of ichthyofauna (Di) were determined. Hydrochemical studies did not show elevated nutrient levels in each reservoir water. In total, from all 8 ponds in a two-year study cycle, 501 fish belonging to 9 species were caught. Among the fish caught by anglers, the largest number of crucian carp (Carassius carassius L.) was recorded, a total of 127 fish of this species were caught in two years of research. Then the most frequently caught fish were perch (Perca fluviatilis L.) and roach (Rutilus rutilus L.) – in both cases 92 individuals. The highest dominance coefficient was recorded in crucian carp (25.25%), and the lowest was recorded in ide (0.20%). Also, the highest values of coefficients of constancy were found in crucian carp (87.5%), and tench (75.0%). In a two-year cycle of research, 99 angling questionnaires were distributed, and ZW1 (35 anglers) was the largest water reservoir with the largest number of anglers