The perception of nurses and doctors on a care bundle guideline for management of pain in critical care

Objetivo: el objetivo de este estudio fue explorar la percepción de las enfermeras y los médicos sobre el uso de un paquete de aten- ción como una guía para el manejo del dolor en cuidados críticos. A pesar del desarrollo de guías y protocolos para el manejo del dolor en cuidados críticos, basados en la evidencia, el dolor sigue siendo un problema importante. La introducción de un paquete de atención para cuidados críticos ha mejorado el manejo de los pacientes ventilados. Un paquete de atención en el manejo del dolor tiene como objetivo reducir las variaciones en la práctica. Método: el estudio tiene un diseño prospectivo cualitativo desarrollado mediante una entrevista en profundidad y semi-estructurada de 23 enfermeros y médicos en una unidad de cuidado crítico. Resultado: cuatro temas principales surgieron: 1 ) la adecuación al escenario de cuidado crítico, 2) la aplicabilidad al escenario de cuidado crítico, 3 ) la propiedad del Paquete de Atención al Dolor, y 4) la necesidad en la práctica actual. Los resultados mostraron una pobre aceptación del paquete por parte de los profesionales de la salud en el manejo de dolor agudo en los enfermos críticos. Conclusión: el estudio encontró que las enfermeras y los médicos no percibieron el paquete de atención al dolor como una herramienta útil para mejorar el manejo del dolor, con pruebas que apuntan a una brecha entre la práctica del manejo del dolor, tal como se describe por el paquete de atención, y la práctica real.</jats:p

The effect of information booklets on family members' satisfaction with decision making in an Intensive Care Unit of Malaysia

Background: To test the effect of information booklets on family members’ satisfaction with decision-making around the care of critically ill patients in an intensive care unit. Design: Quasi-experiment with non-randomized study groups, using a pre and post-test design was used to test the effectiveness of the information booklet. Setting: The study was conducted in a medical center in Malaysia. Subjects: 84 family members of critically ill patients were conveniently assigned to an intervention group and a control group. Intervention: On admission day after consented, completed pre-test questionnaires. The intervention group received the information booklet and will be explained in 20-30 minutes; control group received routine information if any. Day-2: reinforcement on information about 10-20 minutes for intervention group only. Day-3: completion of the post-test questionnaire by both groups. Main outcome measures: The Family Satisfaction–Intensive Care Unit (FS-ICU) and Quality of Communication (QOC) instrument were used to measure families’ satisfaction level. Results: There are significant differences in Family Satisfaction between the intervention and control groups. There was an increase in satisfaction across the pre- and post-test mean values, 54.05 (SD=10. 23) and 71.1 (SD=19.10), respectively; a significant increase in family satisfaction for the intervention group who received the information booklets. Conclusion: The study findings confirm that the information booklets results in a substantial increase in family satisfaction regarding decision-making for patients’ care. Key-words: Decision making, Family satisfaction, Information need, Intensive care unit, Structured Communication

The Perception of Nurses and Doctors on a Care Bundle Guideline for Management of Pain in Critical Care

Objective: The aim of this study was to explore nurses’ and doctors’ perception on using a care bundle as a guideline for the manage- ment of pain in critical care. Despite the development of evidence-based guidelines and protocols on the management of pain in critical care, pain is still a major problem. The introduction of care bundles in critical care has improved the management of ventilated patients. A care bundle in pain management aims to reduce variations in practice. Method: This study employed a qualitative prospective design us- ing a semi-structured, in-depth interview of 23 nurses and doctors in a critical care unit. Result: Four main themes emerged: 1) suitability to the critical care setting; 2) applicability to the critical care setting; 3) ownership of the Pain Care Bundle; and 4) necessity for current practice. The results showed a poor uptake by the healthcare professionals in managing acute pain among critically ill patients. Conclusion: The study found that nurses and doctors did not perceive the pain care bundle as a useful tool for improving pain managment, with evidence pointing to a gap between pain management practice, as described by the care bundle, and actual practice.Objetivo: o objetivo deste estudo foi explorar a percepção das enfermeiras e dos médicos sobre o uso de um pacote de atendimen- to como guia para lidar com a dor em cuidados críticos. Apesar do desenvolvimento de guias e protocolos para lidar com a dor em cuidados críticos, baseados na evidência, a dor continua sendo um problema importante. A introdução de um pacote de atendimento para cuidados críticos vem melhorando o tratamento dado a pacientes ventilados. Um pacote de atendimento no tratamento da dor tem como objetivo reduzir as variações na prática. Método: o estudo tem um desenho prospectivo qualitativo desenvolvido mediante uma entrevista em profundidade e semiestruturada de 23 enfermeiros e médicos em uma unidade de cuidado crítico. Resultado: quatro temas principais surgiram: 1) a adequação ao cenário de cuidado crítico; 2) a aplicabilidade ao cenário de cuidado crítico; 3) a propriedade do Pacote de Atendimento à Dor, e 4) a necessidade na prática atual. Os resultados mostraram uma baixa aceitação do pacote por parte dos profissionais em saúde no tratamento da dor aguda nos doentes críticos. Conclusão: o estudo constatou que as enfermeiras e os médicos não perceberam o pacote de atendimento à dor como uma ferramenta útil para melhorar o tratamento da dor, com provas que apontam a uma brecha entre a prática do tratamento da dor, tal como se descreve pelo pacote de atendimento, e a prática real.  Objetivo: el objetivo de este estudio fue explorar la percepción de las enfermeras y los médicos sobre el uso de un paquete de aten- ción como una guía para el manejo del dolor en cuidados críticos. A pesar del desarrollo de guías y protocolos para el manejo del dolor en cuidados críticos, basados en la evidencia, el dolor sigue siendo un problema importante. La introducción de un paquete de atención para cuidados críticos ha mejorado el manejo de los pacientes ventilados. Un paquete de atención en el manejo del dolor tiene como objetivo reducir las variaciones en la práctica. Método: el estudio tiene un diseño prospectivo cualitativo desarrollado mediante una entrevista en profundidad y semi-estructurada de 23 enfermeros y médicos en una unidad de cuidado crítico. Resultado: cuatro temas principales surgieron: 1 ) la adecuación al escenario de cuidado crítico, 2) la aplicabilidad al escenario de cuidado crítico, 3 ) la propiedad del Paquete de Atención al Dolor, y 4) la necesidad en la práctica actual. Los resultados mostraron una pobre aceptación del paquete por parte de los profesionales de la salud en el manejo de dolor agudo en los enfermos críticos. Conclusión: el estudio encontró que las enfermeras y los médicos no percibieron el paquete de atención al dolor como una herramienta útil para mejorar el manejo del dolor, con pruebas que apuntan a una brecha entre la práctica del manejo del dolor, tal como se describe por el paquete de atención, y la práctica real.

A percepção das enfermeiras e dos médicos sobre o uso de um pacote de atendimento como guia para lidar com a dor em cuidados críticos

DOI: 10.5294/aqui.2013.13.3.2 Objective: The aim of this study was to explore nurses’ and doctors’ perception on using a care bundle as a guideline for the manage- ment of pain in critical care. Despite the development of evidence-based guidelines and protocols on the management of pain in critical care, pain is still a major problem. The introduction of care bundles in critical care has improved the management of ventilated patients. A care bundle in pain management aims to reduce variations in practice. Method: This study employed a qualitative prospective design us- ing a semi-structured, in-depth interview of 23 nurses and doctors in a critical care unit. Result: Four main themes emerged: 1) suitability to the critical care setting; 2) applicability to the critical care setting; 3) ownership of the Pain Care Bundle; and 4) necessity for current practice. The results showed a poor uptake by the healthcare professionals in managing acute pain among critically ill patients. Conclusion: The study found that nurses and doctors did not perceive the pain care bundle as a useful tool for improving pain managment, with evidence pointing to a gap between pain management practice, as described by the care bundle, and actual practice. DOI: 10.5294/aqui.2013.13.3.2DOI: 10.5294/aqui.2013.13.3.2 Objetivo: el objetivo de este estudio fue explorar la percepción de las enfermeras y los médicos sobre el uso de un paquete de aten- ción como una guía para el manejo del dolor en cuidados críticos. A pesar del desarrollo de guías y protocolos para el manejo del dolor en cuidados críticos, basados en la evidencia, el dolor sigue siendo un problema importante. La introducción de un paquete de atención para cuidados críticos ha mejorado el manejo de los pacientes ventilados. Un paquete de atención en el manejo del dolor tiene como objetivo reducir las variaciones en la práctica. Método: el estudio tiene un diseño prospectivo cualitativo desarrollado mediante una entrevista en profundidad y semi-estructurada de 23 enfermeros y médicos en una unidad de cuidado crítico. Resultado: cuatro temas principales surgieron: 1 ) la adecuación al escenario de cuidado crítico, 2) la aplicabilidad al escenario de cuidado crítico, 3 ) la propiedad del Paquete de Atención al Dolor, y 4) la necesidad en la práctica actual. Los resultados mostraron una pobre aceptación del paquete por parte de los profesionales de la salud en el manejo de dolor agudo en los enfermos críticos. Conclusión: el estudio encontró que las enfermeras y los médicos no percibieron el paquete de atención al dolor como una herramienta útil para mejorar el manejo del dolor, con pruebas que apuntan a una brecha entre la práctica del manejo del dolor, tal como se describe por el paquete de atención, y la práctica real. DOI: 10.5294/aqui.2013.13.3.2  Objetivo: o objetivo deste estudo foi explorar a percepção das enfermeiras e dos médicos sobre o uso de um pacote de atendimen- to como guia para lidar com a dor em cuidados críticos. Apesar do desenvolvimento de guias e protocolos para lidar com a dor em cuidados críticos, baseados na evidência, a dor continua sendo um problema importante. A introdução de um pacote de atendimento para cuidados críticos vem melhorando o tratamento dado a pacientes ventilados. Um pacote de atendimento no tratamento da dor tem como objetivo reduzir as variações na prática. Método: o estudo tem um desenho prospectivo qualitativo desenvolvido mediante uma entrevista em profundidade e semiestruturada de 23 enfermeiros e médicos em uma unidade de cuidado crítico. Resultado: quatro temas principais surgiram: 1) a adequação ao cenário de cuidado crítico; 2) a aplicabilidade ao cenário de cuidado crítico; 3) a propriedade do Pacote de Atendimento à Dor, e 4) a necessidade na prática atual. Os resultados mostraram uma baixa aceitação do pacote por parte dos profissionais em saúde no tratamento da dor aguda nos doentes críticos. Conclusão: o estudo constatou que as enfermeiras e os médicos não perceberam o pacote de atendimento à dor como uma ferramenta útil para melhorar o tratamento da dor, com provas que apontam a uma brecha entre a prática do tratamento da dor, tal como se descreve pelo pacote de atendimento, e a prática real.

A percepção das enfermeiras e dos médicos sobre o uso de um pacote de atendimento como guia para lidar com a dor em cuidados críticos

El objetivo de este estudio fue explorar la percepción de las enfermeras y los médicos sobre el uso de un paquete de aten- ción como una guía para el manejo del dolor en cuidados críticos. A pesar del desarrollo de guías y protocolos para el manejo del dolor en cuidados críticos, basados en la evidencia, el dolor sigue siendo un problema importante. La introducción de un paquete de atención para cuidados críticos ha mejorado el manejo de los pacientes ventilados. Un paquete de atención en el manejo del dolor tiene como objetivo reducir las variaciones en la práctica. Método: el estudio tiene un diseño prospectivo cualitativo desarrollado mediante una entrevista en profundidad y semi-estructurada de 23 enfermeros y médicos en una unidad de cuidado crítico. Resultado: cuatro temas principales surgieron: 1 ) la adecuación al escenario de cuidado crítico, 2) la aplicabilidad al escenario de cuidado crítico, 3 ) la propiedad del Paquete de Atención al Dolor, y 4) la necesidad en la práctica actual. Los resultados mostraron una pobre aceptación del paquete por parte de los profesionales de la salud en el manejo de dolor agudo en los enfermos críticos. Conclusión: el estudio encontró que las enfermeras y los médicos no percibieron el paquete de atención al dolor como una herramienta útil para mejorar el manejo del dolor, con pruebas que apuntan a una brecha entre la práctica del manejo del dolor, tal como se describe por el paquete de atención, y la práctica real.  The aim of this study was to explore nurses’ and doctors’ perception on using a care bundle as a guideline for the manage- ment of pain in critical care. Despite the development of evidence-based guidelines and protocols on the management of pain in critical care, pain is still a major problem. The introduction of care bundles in critical care has improved the management of ventilated patients. A care bundle in pain management aims to reduce variations in practice. Method: This study employed a qualitative prospective design us- ing a semi-structured, in-depth interview of 23 nurses and doctors in a critical care unit. Result: Four main themes emerged: 1) suitability to the critical care setting; 2) applicability to the critical care setting; 3) ownership of the Pain Care Bundle; and 4) necessity for current practice. The results showed a poor uptake by the healthcare professionals in managing acute pain among critically ill patients. Conclusion: The study found that nurses and doctors did not perceive the pain care bundle as a useful tool for improving pain managment, with evidence pointing to a gap between pain management practice, as described by the care bundle, and actual practice.O objetivo deste estudo foi explorar a percepção das enfermeiras e dos médicos sobre o uso de um pacote de atendimen- to como guia para lidar com a dor em cuidados críticos. Apesar do desenvolvimento de guias e protocolos para lidar com a dor em cuidados críticos, baseados na evidência, a dor continua sendo um problema importante. A introdução de um pacote de atendimento para cuidados críticos vem melhorando o tratamento dado a pacientes ventilados. Um pacote de atendimento no tratamento da dor tem como objetivo reduzir as variações na prática. Método: o estudo tem um desenho prospectivo qualitativo desenvolvido mediante uma entrevista em profundidade e semiestruturada de 23 enfermeiros e médicos em uma unidade de cuidado crítico. Resultado: quatro temas principais surgiram: 1) a adequação ao cenário de cuidado crítico; 2) a aplicabilidade ao cenário de cuidado crítico; 3) a propriedade do Pacote de Atendimento à Dor, e 4) a necessidade na prática atual. Os resultados mostraram uma baixa aceitação do pacote por parte dos profissionais em saúde no tratamento da dor aguda nos doentes críticos. Conclusão: o estudo constatou que as enfermeiras e os médicos não perceberam o pacote de atendimento à dor como uma ferramenta útil para melhorar o tratamento da dor, com provas que apontam a uma brecha entre a prática do tratamento da dor, tal como se descreve pelo pacote de atendimento, e a prática real.

The Perception of Nurses and Doctors on a Care Bundle Guideline for Management of Pain in Critical Care

DOI: 10.5294/aqui.2013.13.3.2 Objective: The aim of this study was to explore nurses’ and doctors’ perception on using a care bundle as a guideline for the manage- ment of pain in critical care. Despite the development of evidence-based guidelines and protocols on the management of pain in critical care, pain is still a major problem. The introduction of care bundles in critical care has improved the management of ventilated patients. A care bundle in pain management aims to reduce variations in practice. Method: This study employed a qualitative prospective design us- ing a semi-structured, in-depth interview of 23 nurses and doctors in a critical care unit. Result: Four main themes emerged: 1) suitability to the critical care setting; 2) applicability to the critical care setting; 3) ownership of the Pain Care Bundle; and 4) necessity for current practice. The results showed a poor uptake by the healthcare professionals in managing acute pain among critically ill patients. Conclusion: The study found that nurses and doctors did not perceive the pain care bundle as a useful tool for improving pain managment, with evidence pointing to a gap between pain management practice, as described by the care bundle, and actual practice. DOI: 10.5294/aqui.2013.13.3.

Survey on patient’s satisfaction on the service quality in an emergency department in Malaysia

Patients' experience in the emergency department in terms of service, communication, waiting time, competence and facility are important indicators in improving quality care. The aim of this study was to explore patient’s satisfaction level on care of five domains; services, communication, waiting time, competence and facility in the emergency department. A cross-sectional study design using PEQ (Patient Experience Questionnaire). Convenience sampling method used requiring participants to complete the questionnaire prior to discharge. Data was analysed with SPSS version 20. Descriptive and Pearson Chi Square was used to determine the association.324 questionnaires returned. Descriptive analysis showed 67.9% were not satisfied with their experiences. The mean service scored 65.90 ± 31.91, communication scored 65.00 ± 35.76, facility scored 63.33 ± 34.53, competence scored 54.89 ± 35.18 and waiting time scored 49.77 ± 32.65. Service has significance association with education and age group. This study has showed the importance of communication skill and a well-organized emergency department right from the triage till discharge to improve the satisfaction level of patients. Hence the department should recognize these needs and increase the provision of training need for staff in order in contribution to improve the communication skill of the healthcare provider

Nurses’ perceptions of barriers and facilitators and their associations with the quality of end-of-life care

Aims and objectives: To examine nurses’ perceptions of barriers to and facilitators of end-of-life care, as well as their association with the quality of end-of-life care. Background: Often, dying patients and their families receive their care from general nurses. The quality of end-of-life care in hospital wards is inadequate. Method: A self-administered questionnaire was completed by 553 nurses working in a tertiary teaching hospital in Malaysia. Results: The barrier with the highest mean score was “dealing with distressed family members.” The facilitator with the highest mean score was “providing a peaceful and dignified bedside scene for the family once the patient has died.” With regard to barrier and facilitator categories, the barrier category with the highest total mean score was patient-related barriers and the facilitator category with the highest total mean score concerned facilitators related to healthcare professionals. In the multivariate analysis, age, patient family-related barriers and healthcare professional-related facilitators significantly predict the quality of end-of-life care. Conclusion: The results of this study suggest that there is an urgent need to overcome barriers related to the patient and family members that hinder the quality of care provided for dying patients, as well as to enhance and implement the facilitators related to healthcare providers. In addition, there is also a need to enhance the quality of end-of-life care provided by younger nurses through end-of-life care courses and training. Relevance to clinical practice: Helping nurses overcome barriers and implement facilitators may lead to enhanced quality of care provided for dying patients

Effect of a reminder system using an automated short message service on medication adherence following acute coronary syndrome

Background:Medication non-adherence leads to a vast range of negative outcomes in patients with coronary artery disease. An automated web-based system managing short message service (SMS) reminders is a telemedicine approach to optimise adherence among patients who frequently forget to take their medications or miss the timing.Aim:This paper sought to investigate the effect of automated SMS-based reminders on medication adherence in patients after hospital discharge following acute coronary syndrome (ACS).Methods:An interventional study was conducted at a tertiary teaching hospital in Malaysia. A total of 62 patients with ACS were equally randomised to receive either automated SMS reminders before every intake of cardiac medications or only usual care within eight weeks after discharge. The primary outcome was adherence to cardiac medications. Secondary outcomes were the heart functional status, and ACS-related hospital readmission and death rates.Results:There was a higher medication adherence level in the intervention group rather than the usual care group, (χ2 (2)=18.614, p<0.001). The risk of being low adherent among the control group was 4.09 times greater than the intervention group (relative risk =4.09, 95% confidence interval (CI) 1.82–9.18). A meaningful difference was found in heart functional status between the two study groups with better results among patients who received SMS reminders, (χ2 (1) = 16.957, p<0.001).Conclusion:An automated SMS-based reminder system can potentially enhance medication adherence in ACS patients during the early post-discharge period