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

An Educational Intervention Incorporating Digital Storytelling to Implement Family Nursing Practice in Acute Care Settings

This project describes implementation of an educational intervention designed to initiate practice changes that support families and nurses during acute illness. An academic–practice partnership and digital storytelling methodology provided a foundation. A quasi-experimental research design included quantitative and qualitative measurement before and after the educational intervention. Themes identified in digital stories of nurse experiences caring for families provided direction for the educational intervention including the digital stories, empirical evidence, and proposed changes in nursing practice focused on families. Nurse participants (n = 160) in the educational intervention reported positive responses on a qualitative questionnaire. Comparing pretest and posttest results of the Family Nurse Practice Scale reflected positive, though not significant change. Family members (n = 49) reported significantly improved perceptions of support on 7 of the 14 items on the Iceland Perceived Family Support Questionnaire. This project highlighted digital storytelling’s power to promote family interventions and move family nursing knowledge into practice

Reducing Digital Storytelling Implementation Barriers in Nursing Education Workshops

Digital stories have the potential to transform health care systems by cultivating understanding and compassion; however, limited research explores the use of this innovative strategy in continuing education. This article describes how a collaborative partnership of an Academic Team and Translational Partners (n = 15) implemented a four-phase study that included a continuing education workshop with digital stories as the central strategy. The study\u27s guiding questions focused on adapting approaches to creating digital stories to reduce logistic concerns and overcome implementation challenges yet empower nurses in their practice with families. Numerical and narrative responses from workshop participant evaluations (n = 160) affirmed storytelling as the most valuable component, and reflection increased understandings to influence their thinking and actions. This study affirms using digital stories as an implementation strategy in health care systems has the potential to transform nursing education, supports the transfer of family nursing practice knowledge, encourages reflection, and develops empathy for families and nurse peers

Reducing Technical Challenges Of The Digital Storytelling Approach During An Academic-Practice Partnership

This presentation will describe how digital storytelling was used to assist with the transfer of family nursing knowledge to practice during an academic-practice partnership in an adult ICU setting. Modifications to established digital storytelling methods and alternatives to known limitations such as technical demand and time constraint will be discussed

An Academic-Practice Partnership Enhances Family Nursing in an Adult ICU Setting

This presentation describes the benefits and challenges of a partnership between a school of nursing and a large, urban teaching hospital and how such a partnership can engage nurses at the bedside while informing scholarship for nursing faculty

The Ethical, Care, and Client-Caregiver Relationship Impacts Resulting From Introduction of Digital Communication and Surveillance Technologies in the Home Setting: Qualitative Inductive Study

BackgroundEmbedding communication and surveillance technology into the home health care setting has demonstrated the capacity for increased data efficiency, assumptions of convenience, and smart solutions to pressing problems such as caregiver shortages amid a rise in the aging population. The race to develop and implement these technologies within home care and public health nursing often leaves several ethical questions needing to be answered. ObjectiveThe aim of this study was to understand the ethical and care implications of implementing digital communication and surveillance technologies in the home setting as perceived by health caregivers practicing in the region of Halland in Sweden with clients receiving home care services. MethodsA questionnaire was completed by 1260 home health caregivers and the written responses were evaluated by qualitative inductive content analysis. The researchers reviewed data independently and consensus was used to determine themes. ResultsThis study identified three main themes that illustrate ethical issues and unintended effects as perceived by caregivers of introducing digital communication and surveillance technologies in the home: (1) digital dependence vulnerability, (2) moral distress, and (3) interruptions to caregiving. This study highlights the consequences of technology developers and health systems leaders unintentionally ignoring the perspectives of caregivers who practice the intuitive artistry of providing care to other humans. ConclusionsBeyond the obtrusiveness of devices and impersonal data collection designed to emphasize health care system priorities, this study discovered a multifaceted shadow side of unintended consequences that arise from misalignment between system priorities and caregiver expertise, resulting in ethical issues. To develop communication and surveillance technologies that meet the needs of all stakeholders, it is important to involve caregivers who work with clients in the development process of new health care technology to improve both the quality of life of clients and the services offered by caregivers

Reducing Digital Storytelling Implementation Barriers in Nursing Education Workshops

Digital stories have the potential to transform health care systems by cultivating understanding and compassion; however, limited research explores the use of this innovative strategy in continuing education. This article describes how a collaborative partnership of an Academic Team and Translational Partners (n = 15) implemented a four-phase study that included a continuing education workshop with digital stories as the central strategy. The study\u27s guiding questions focused on adapting approaches to creating digital stories to reduce logistic concerns and overcome implementation challenges yet empower nurses in their practice with families. Numerical and narrative responses from workshop participant evaluations (n = 160) affirmed storytelling as the most valuable component, and reflection increased understandings to influence their thinking and actions. This study affirms using digital stories as an implementation strategy in health care systems has the potential to transform nursing education, supports the transfer of family nursing practice knowledge, encourages reflection, and develops empathy for families and nurse peers