Family Presence on Multidisciplinary Patient Care Rounds in ICU
Condition: Critical Illness
MeSH terms: Critical Illness
Study type: Interventional

Summary: 
      Family presence on patient care rounds in adult intensive care units remains the least
      studied area of family-centered care. Despite support from professional organizations and
      critical care experts, very few critical care units in the United States have written
      policies allowing family presence (Davidson, 2013). This multidisciplinary prospective,
      quasi-experimental design study examined if there is a difference in patient and family
      satisfaction between rounding in the presence of family compared to patient rounding without
      family members in the adult intensive care unit and determined the nurses' and health care
      professionals' attitudes toward family presence during multidisciplinary patient care rounds
      in the ICU of two hospitals. The sample was 150 patients and family members (75 per hospital)
      and a convenience sampling of 90 healthcare professionals from the two sites. This
      investigation will have a potential impact on nursing practice and research. Findings
      obtained from this study may provide further concrete information on the effect of family
      presence during multidisciplinary patient care rounds, and patient and family satisfaction
      that will develop policies and standardized approaches to rounding processes that are
      innovative in diverse critical care settings as well as other non-critical care settings.
      Data obtained from this research will be used to create patient and family-centered care
      plans, add new knowledge and educational programs for healthcare professionals
    

Detailed description: 
      Purpose/Specific Aims The overall goal of this multidisciplinary, multisite
      quasi-experimental study was to determine whether family presence and engagement during
      patient-and-family-centered interdisciplinary rounds (PFCC-IR) impacts nurses' and health
      care professionals' attitudes and patient and family satisfaction with their intensive care
      unit (ICU) stay. A. Objectives

      (1) To examine if there is a difference in patient and family satisfaction between rounding
      in the presence of family compared to patient rounding without family members in the adult
      intensive care unit (ICU) using the Patient Satisfaction with Nursing Care Quality
      Questionnaire ([PSNCQQ], and the Critical Care Family Satisfaction Survey ([CCFSS]; and, (2)
      To determine ICU nurses' and health care professionals' attitudes toward family presence
      during PFCC-IR using the Families' Importance in Nursing Care-Nurse's Attitudes ([FINC-NA]
      scale

      B. Hypotheses / Research Question(s) The present study hypothesized that:

      H1: There will be greater patient satisfaction when rounding with family present compared to
      without family present. H2: There will be differences in attitudes towards family presence
      during PFCC-IR.

      Research Design and Methods: This multisite quasi-experimental study was conducted in an
      adult ICU of two hospitals in southern New Jersey. Approval from the Institutional Review
      Board (IRB) was obtained before the initiation of the study. Informed consent was obtained
      from the patients, family members, nurses, and health care professionals. The sample consists
      of 150 patients and family members (75 dyads per hospital) and 90 healthcare professionals (n
      = 390 total) that included the ICU Attendings/Intensivists, Fellows, medical residents,
      respiratory therapists, physical therapists, pharmacists, dietitians and a social worker.
      Three instruments were used: the FINC-NA, the PSNCQQ, and the CCFSS. The PFCC-IR were led by
      the ICU Attending or Intensivist. Duration for Study and Each Subject: The patient and family
      members' participation in the study took 30 minutes to one hour for the rounds, and another
      20-30 minutes to complete the survey for an overall total participation time of 2.5 hours.

      Sample Size Justification: A sample of 75 dyads or 150 patients and family members was the
      projected target sample size for this study. Power analysis for the study was calculated
      based on 80% power to detect a difference, with a significance level of 0.05 (2-tailed), in
      means of 0.4 with a standard error of 0.8.

      Data Collection: All data were collected by the PI after having all subjects signed the
      informed consent. Family members or significant others attended one to two PFCC-IR on the
      first week of admission while the patient is in the ICU. The patient questionnaire was given
      to the patient by the PI to be completed at the time of discharge or within 24 hours of
      discharge from the ICU.

      The family member and/or significant other questionnaires were administered on the day of the
      patient's discharge from the ICU or within 48 hours of discharge from the ICU. All eligible
      ICU nurses and health care professionals were given a survey packet by the PI at the
      beginning and end of the study. Completed questionnaires was returned in a drop box in the
      ICU.

      Consent Procedures: The consent process took place in a private room in the ICU of the
      hospital. The PI followed-up and scheduled a bedside contact to explain the study fully to
      the patient during visiting hours or over the telephone.

      All questions from subjects were answered by the PI. The patient and family members were
      given enough time that they need to read and understand the content of informed consent.
      Informed consents were obtained from all the 390 subjects in this study.

      Economic Burden and/or Compensation for Subjects: Subjects did not incur any expenses by
      participating in this study. No remuneration was given to the subjects.

      Risks and Benefits to Subjects: Patients and family members who gave consent participated in
      the PFCC-IR. No untoward events occurred when the intervention was administered for the whole
      duration of the study. There are no withdrawal or attrition of subjects.

      Current guidelines recommend for families of ICU patients to participate PFCCIR to facilitate
      patient-family-centered-care. However, there has been relatively little research to inform
      best practices. Findings obtained from this study may provide further new knowledge on the
      effect of family presence during PFCCIR, and patient and family satisfaction that will help
      establish policies and a standardized approach to rounding processes that can be applied,
      further developed and implemented in different critical care settings as well as other
      non-critical care settings. Further, it may decrease the ambivalence expressed by diverse
      health care providers and limit practice variation.

      Data Analysis: Data analysis for this study is in progress using the latest version of the
      SPSS software.

      Data Security: Subjects were made aware that they have the right to privacy and that their
      identities will not be revealed, and the confidentiality of information will be ensured.
      Identity protection and confidentiality were fully expressed in the consent form. All the
      data that were collected are stored in a password protected computer located in the
      researcher's office. Hard copies of transcripts and narratives are stored in a locked cabinet
      in the researcher's office in the university, to assure safety and preserve the privacy and
      confidentiality of all participants.

      .
    

Intervention name(s): Participation in PFCC-IR
Intervention type(s): Other
Intervention description(s): Patient-and-family-centered-care interdisciplinary rounds (PFCC-IR) with the critical care team are standard practice in the ICU but it doesn't usually include family members. The intervention for this study is PFCC-IR that include one family member of the patient.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: control group: 150 patients and one family member experimental group: 150 patients and one family member; 90 healthcare professionals (no intervention, convenience sampling. cross-sectional data collection)
Masking: None (Open Label)
Primary purpose: Supportive Care