Implementation of the evidence for the improvement of nursing care to the critical patient’s family: a Participatory Action Research
Tóm tắt
There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Therefore, the purpose of the study is to understand the change process aimed at improving care to critical patient’s families, and to explore the evolution of patterns of knowing that nurses use in this process. Qualitative study with a Participatory Action Research method, in accordance with the Kemmis and McTaggart model. In this model, nurses can observe their practice, reflect upon it and compare it with scientific evidence, as well as define, deploy and evaluate improvement strategies adapted to the context. Simultaneously, the process of empowerment derived from the Participatory Action Research allows for the identification of patterns of knowing and their development over time. The research will take place in the Intensive Care Units of a tertiary hospital. The participants will be nurses who are part of the regular workforce of these units, with more than five years of experience in critical patients, and who are motivated to consider and critique their practice. Data collection will take place through participant observation, multi-level discussion group meetings and documentary analysis. A content analysis will be carried out, following a process of codification and categorisation, with the help of Nvivo10. The approval date and the beginning of the funding were December 2012 and 2013, respectively. The definition, introduction and evaluation of care strategies for family members will allow for their real and immediate implementation in practice. The study of the patterns of knowing in the Participatory Action Research will be part of the theoretical and practical feedback process of a professional discipline. Also, the identification of the construction and evolution of knowledge will provide decision elements to managers and academics when choosing strategies for increased quality.
Tài liệu tham khảo
Zaforteza C, Gastaldo D, Sánchez-Cuenca P, de Pedro JE, Lastra P. Relación entre enfermeras de unidades de cuidados intensivos y familiares: Indicios para el cambio [The relationship between Intensive Care Unit nurses and patients’ relatives: Trends for change]. Nure Investig [on-line]. 2004; March 3. http://www.nureinvestigacion.es/OJS/index.php/nure/article/view/133. Accessed 10 June 2015.
Zaforteza C, García A, Quintana R, Sánchez C, Abadía E, Miró JA. Abrir la unidad de cuidados intensivos a los familiares: ¿qué opinan los profesionales? [opening the intensive care unit to families: what do the professionals think?]. Enferm Intensiva. 2010;21(2):52–7. https://doi.org/10.1016/j.enfi.2009.03.001.
Sims JM, Miracle VA. A look at critical care visitation. The case for flexible visitation. Dimens Crit Care Nurs. 2006;25(4):175–80.
Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, Levy MM. Visiting hours policies in New England intensive care units: strategies for improvement. Crit Care Med. 2007;35(2):497–501. https://doi.org/10.1097/01.CCM.0000254338.87182.AC.
Anzoletti AB, Buja A, Bortolusso V, Zampieron A. Access to intensive care units: a survey in north-East Italy. Intensive Crit Care Nurs. 2008;24(6):366–74. https://doi.org/10.1016/j.iccn.2008.04.004.
Vandijck DM, Labeau SO, Geerinckx CE, De Puydt E, Bolder AC, Claes B, et al. An evaluation of family-centered care services and organization of visiting policies in Belgian intensive care units: a multicenter survey. Heart Lung. 2010;39(2):137–46. https://doi.org/10.1016/j.hrtlng.2009.06.001.
Spreen AE, Schuurmans MJ. Visiting policies in the adult intensive care units: a complete survey of Dutch ICUs. Intensive Crit Care Nurs. 2011;27(1):27–30. https://doi.org/10.1016/j.iccn.2010.10.002.
Velasco JM, Prieto JF, Castillo J, Merino N, Perea-Milla E. Organización de las visitas en las unidades de cuidados intensivos en España. [Organization of visits in Spanish ICU]. Enferm Intensiva. 2005;16(2):73–83.
Plakas S, Cant B, Taket A. The experiences of families of critically ill patients in Greece: a social constructionist grounded theory study. Intensive Crit Care Nurs. 2009;25(1):10–20. https://doi.org/10.1016/j.iccn.2008.04.003.
Delgado-Hito P, Sola A, Mirabete I, Torrents R, Blasco M, Barrero R, et al. Modificación de la práctica enfermera a través de la reflexión: una investigación-acción participativa [Modification of nursing practice through reflection: participatory action research]. Enferm Intensiva. 2001;12(3):110–26.
Torres L, Morales JM. Participación familiar en el cuidado del paciente crítico. Recomendaciones de la Sociedad Andaluza de Enfermería de Cuidados Críticos. [Family involvement in critically-ill patient care. Recommendations of the Andalusian Society for Critical Care Nursing]. Tempus Vitalis. 2004;4(1):18–25.
Rubio L, Cosi M, Martínez C, Miró A, Ll S, Toda D, et al. Relaciones interdisciplinarias y humanización en las unidades de cuidados intensivos [Interdisciplinary relationships and humanization in intensive care units]. Enferm Intensiva. 2006;17(4):141–53.
Coyer F, Courtney M, O’Sullivan J. Establishing an action research group to explore family-focused nursing in the intensive care unit. Int J Nurs Pract. 2007;13:14–23. https://doi.org/10.1111/j.1440-172X.2006.00604.x.
Stayt LC. Nurses’ experiences of caring for families with relatives in intensive care units. J Adv Nurs. 2007;57(6):623–30. https://doi.org/10.1111/j.1365-2648.2006.04143.x.
Blanchard D, Alavi C. Asymmetry in the intensive care unit: redressing imbalance and meeting the needs of family. Nurs Crit Care. 2008;13(5):225–31. https://doi.org/10.1111/j.1478-5153.2008.00292.x.
Zaforteza C, Sánchez C, Lastra P. Análisis de la literatura sobre los familiares del paciente crítico: es necesario desarrollar investigación en cuidados efectivos [analysis of the literature on the relatives of the critical patient: research in effective care needs to be performed]. Enferm Intensiva. 2008;19(2):61–70.
Llamas-Sánchez F, Flores J, Acosta ME, González J, Albar MJ, Macías C. Necesidades de los familiares en una Unidad de Cuidados Críticos [Needs of the families in a Critical Care Unit]. Enferm Intensiva. 2009;20(2):50–7.
Delgado-Hito P. Le processus de production de savoirs dans la pratique infirmière au moyen de la réflexivité [The process of knowledge production within nursing practice through reflexivity]. Ph. D. University of Montreal. 2010. http://hdl.handle.net/1866/4179 Accessed 20 July 2015.
Zaforteza C, Prieto S, Canet TP, Díaz Y, Molina M, Moreno C, et al. Mejorando el cuidado a los familiares del paciente crítico: estrategias consensuadas [Improving the case of critical patient family members: Agreed on strategies]. Enferm Intensiva. 2010;21(1):11–9. https://doi.org/10.1016/j.enfi.2009.07.002.
Pardavila MI, Vivar CG. Necesidades de las familias en las unidades de cuidados intensivos [Needs of the families in Critical Care Units]. Literature review. Enferm Intensiva. 2012;23(2):51–67. doi:https://doi.org/10.1016/j.enfi.2011.06.001.
Kim H, Rose K.M. Concept analysis of family homeostasis. J Adv Nurs 2014, 70(11):2450–2468. doi: https://doi.org/10.1111/jan.12496.
Verhaeghe S, Defloor T, Van Zuuren F, Duijnstee M, Grypdonk M. The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature. J Clin Nurs. 2005;14(4):501–9. https://doi.org/10.1111/j.1365-2702.2004.01081.x.
Kutash M, Northrop L. Family members’ experiences of the intensive care unit waiting room. J Adv Nurs. 2007;60(4):384–8. https://doi.org/10.1111/j.1365-2648.2007.04388.x.
García A, Sánchez F, Amorós SM, Balaguer A, Díez M, Durán MT, et al. Desarrollo de una guía de atención a los familiares del paciente crítico [Development of an attention guideline for the critical patient's family]. Enferm Intensiva. 2010;21(1):20–7. https://doi.org/10.1016/j.enfi.2009.07.001.
Hidalgo I, Vélez Y, Pueyo E. Qué es importante Para los familiares de los pacientes de una Unidad de Cuidados Intensivos [what is important for the family of patients in the intensive care unit]. Enferm Intensiva. 2007;18(3):106–14.
Paul F, Rattray J. Short- and long-term impact of critical illness on relatives: literature review. J Adv Nurs. 2008;62(3):276–92. https://doi.org/10.1111/j.1365-2648.2007.04568.x.
Davidson JE. Family-centered care. Meeting the needs of patients’ families and helping families adapt to critical illness. Crit Care Nurse. 2009;29(3):28–34. https://doi.org/10.4037/ccn2009611.
McAdam JL, Puntillo K. Symptoms experienced y family members of patients in intensive care units. Am J Crit Care. 2009;18(3):200–9. https://doi.org/10.4037/ajcc2009252.
Hinkle JL, Fitzpatrick E. Needs of American relatives of intensive care patients: perceptions of relatives, physicians and nurses. Intensive Crit Care Nurs. 2011;27(4):218–25. https://doi.org/10.1016/j.iccn.2011.04.003.
Siddiqui S, Sheikh F, Kamal R. What families want- an assessment of family expectations in the ICU. Int Arch Med. 2011;4:21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130654/. Accessed 30 Aug 2011.
Vázquez M, Eseverri MC. El cuidado de las familias en las unidades de cuidados intensivos desde la perspectiva de Jean Watson [the caring of family members in the intensive care units from the Jean Watson perspective]. Enferm Intensiva. 2010;21(4):161–4. https://doi.org/10.1016/j.enfi.2010.03.004.
Engström B, Uusitalo A, Engström A. Relatives’ involvement in nursing care: a qualitative study describing critical care nurses’ experiences. Intensive Crit Care Nurs. 2011;27(1):1–9. https://doi.org/10.1016/j.iccn.2010.11.004.
Williams CM. The identification of family members’ contribution to patients’ care in the intensive care unit: a naturalistic inquiry. Nurs Crit Care. 2005;10:6–14.
Engström A, Söderberg S. Close relatives in intensive care from the perspective of critical care nurses. J Clin Nurs. 2007;16(9):1651–9. https://doi.org/10.1111/j.1365-2702.2005.01520.x.
Zaforteza C, Gastaldo D, de Pedro JE, Sánchez-Cuenca P, Lastra P. The process of giving information to families of critically ill patients: a field of tension. Int J Nurs Stud. 2005;42:135–45.
Marco L, Bermejillo I, Garayalde N, Sarrate I, Margall MA, Asiain MC. Intensive care nurses’ beliefs and attitudes towards the effect of open visiting on patients, family and nurses. Nurs Crit Care. 2006;11(1):33–41.
Santana L, Yañez B, Martín J, Ramírez F, Roger I, Susilla A. Actividades de comunicación del personal de enfermería con los familiares de pacientes ingresados en una unidad de cuidados intensivos [nurse activities for communicating with the families of patients admitted to an intensive care unit]. Enferm Clin. 2009;19(6):335–9. https://doi.org/10.1016/j.enfcli.2009.02.007.
Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, et al. Clinical practice guidelines for support of the family in the patient-centered intensive unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007;35(2):605–22. https://doi.org/10.1097/01.CCM.0000254067.14607.EB.
Garrouste-Orgeas M, Philippart F, Timsit JF, Diaw F, Willems V, Tabah A, et al. Perceptios of a 24-hour visiting policy in the intensive care unit. Crit Care Med. 2008;36(1):30–5. https://doi.org/10.1097/01.CCM.0000295310.29099.F8.
Garrouste-Orgeas M, Coquet I, Périer A, Timsit JF, Pochard F, Lancrin F, et al. Impact of an intensive care unit diary on phychological distress in patients and relatives. Crit Care Med. 2012;40(7):2033–40. https://doi.org/10.1097/CCM.0b013e31824e1b43.
Torrents R, Oliva E, Saucedo MJ, Ll S, Jover C. Impacto de los familiares del paciente crítico ante una acogida protocolizada [impact of the relatives of the critical patient. In light of a protocolized reception]. Enferm Intensiva. 2003;14(2):49–60.
Zaforteza C, García A, Amorós SM, Pérez E, Maqueda M, Delgado J. Elementos facilitadores y limitadores del cambio en la atención a los familiares del paciente crítico [limiting and facilitating factors of changes in the care of families of the critically ill patient]. Enferm Intensiva. 2012;23(3):121–31. https://doi.org/10.1016/j.enfi.2011.12.006.
de-la-Cueva-Ariza L. La realidad de los cuidados a la familia del paciente crítico en España: la necesidad de actuar ya [the reality of cares to the family of the critical patient in Spain: action must be taken now]. Enferm Intensiva. 2012;23(4):153–4. http://dx.doi.org/10.1016/j.enfi.2012.10.003
Scott-Findlay S, Golden-Biddle K. Understanding how organizational culture shapes research use. J Nurs Adm. 2005;35(7–8):359–65.
Abad-Corpa E, Meseguer-Liza C, Martínez-Corbalán JT, Zárate-Riscal L, Caravaca-Hernández A, Paredes-Sidrach de Cardona A, et al. Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocol. J Adv Nurs. 2010;66(8):1845–51. https://doi.org/10.1111/j.1365-2648.2010.05305.x.
Buckley P, Andrews T. Intensive care nurses’ knowledge of critical care family needs. Intensive Crit Care Nurs. 2011;27(5):263–72. https://doi.org/10.1016/j.iccn.2011.07.001.
Hills MD, Mullett J. Enhancing nursing health promotion through cooperative inquiry. In: Young LE, Hayes V, editors. Transforming health promotion practice: concepts, issues and applications. Philadelphia: Davis Company; 2002. p. 311–22.
Meleis AI. Our syntax: an epistemological analysis. In: Meleis AI, editor. Theoretical nursing. Development and progress. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 486–514.
Benner PE. From novice to expert: excellence and power in clinical nursing practice. Menlo Park (California): Addison-Wesley; 1984.
Carlsson G, Dahlberg K, Drew N. Encountering violence and aggression in mental health nursing: a phenomenological study of tacit caring knowledge. Issues Ment Health Nurs. 2000;21:533–45.
Chinn PL, Kramer MK. Integrated theory and knowledge development in nursing. 7th ed. St. Louis: Mosby Elsevier; 2008.
Mantzoukas S, Jasper M. Types of nursing knowledge used to guide care of hospitalized patients. J Adv Nurs. 2008;62(3):318–26. https://doi.org/10.1111/j.1365-2648.2007.04587.x.
Carper B. Fundamental patterns of knowing in nursing. ANS Adv Nurs Sci. 1978;1(1):13–23.
White J. Patterns of knowing: review, critique and update. ANS Adv Nurs Sci. 1995;17(4):76–86.
Chinn PL, Kramer MK. Integrated theory and knowledge development in nursing. 8th ed. St. Louis: Mosby Elsevier; 2011.
Schaefer KM. Reflections on caring narratives: enhancing patterns of knowing. Nurs Educ Perspect. 2002;23(6):286–93.
Hunter LA. Stories as integrated patterns of knowing in nursing education. Int J Nurs Educ Scholarsh. 2008;5(1):38. https://doi.org/10.2202/1548-923X.1630. Accessed 7 July 2014.
Rubarth LB. Nursing Patterns of Knowing in assessment of newborn sepsis. Ph. D. The University of Arizona; 2005.
Guadron MB. Identification of patterns of knowing used by rural community health nurses in decision-making. Ph.D. Binghamton University; 2008.
Guba EG, Lincoln YS. What is this constructivist paradigm anyway? In: Guba EG, Lincoln YS, editors. Fourth generation evaluation. London: SAGE Publications; 1989. p. 79–116.
Guba EG, Lincoln YS. Paradigmatic controversies, contradictions, and emerging confluences. In: Denzin NK, Lincoln YS, editors. The sage handbook of qualitative research. 3rd ed. London: SAGE Publications; 2005. p. 191–216.
Guba EG. The alternative paradigm dialog. In: Guba EG, editor. The paradigm dialog. London: SAGE Publications; 1990. p. 17–28.
Kemmis S, McTaggart R. The action research planner. 3rd ed. Australia: Deakin University Press; 1988.
Callejo J. El grupo de discusión: introducción a una práctica de investigación [the discussion group: introduction to a research practice]. Barcelona: Ariel Practicum; 2001.
Valles MS. Técnicas de observación y participación [observation and participation techniques]. In: Valles MS, editor. Técnicas cualitativas de investigación social. Madrid: Síntesis S.A; 2000. p. 141–75.
Morgan DL. Deciding on group size. In: Morgan DL, Scannell AU, editors. Planning focus groups. Focus group kit2. London: SAGE Publications; 1998. p. 71–6.
Delgado-Hito P, Gastaldo D. Avaliaçao participativa da assistência en enfermagem em uma unidade de cuidados intensivos na Espanha. Da reflexao à mudança nas práticas do cuidado. In: Bosi ML, Mercado FJ, editors. Avaliaçao qualitativa de programas de saúde [Participatory evaluation of nursing care in a critical care unit in Spain. From reflection to a change of care practices. In: Qualitative evaluation of health programs] Vozes: Petrópolis, 2006. p. 281–312.
Kemmis S, McTaggart R, Nixon R. The action research planner. Doing critical participatory action research. London: Springer; 2014.
Sorell JM. Remembrance of things past through writing: esthetic patterns of knowing in nursing. ANS Adv Nurs Sci. 1994;17(1):60–70.
McTaggart R. Participatory action research. Albany: State University or New York Press; 1997.
Spradley JP. Participant observation. New York: Holt, Rinehart & Winston; 1980.
Thorne S. Data analysis in qualitative research. Evid Based Nurs [on-line. 2000;(3):68–70. https://doi.org/10.1136/ebn.3.3.68. Accessed 5 Apr 2015.
Morse JM, Field PA. Principles of data analysis. In: Morse JM, Field PA, editors. Qualitative research methods for health professionals. 2nd ed. London: SAGE Publications; 1995. p. 125–50.
Lincoln YS, Guba EG. Establishing trustworthiness. In: Lincoln YS, Guba EG, editors. Naturalistic inquiry. London: SAGE Publications; 1985. p. 289–331.
Mays N, Pope C. Assessing quality in qualitative research. BMJ. 2000;320(7226):50–2.
Calderón C. Criterios de calidad en la investigación cualitativa en salud (ICS): apuntes para un debate necesario [Quality criteria in Qualitative Research in Health: notes for a necessary debate]. Rev Esp Salud Publica. 2002;76(5):473–82.
de la Cuesta-Benjumea C. La reflexivilidad: un asunto crítico en la investigación cualitativa [Reflexivity: a critical issue in qualitative research]. Enferm Clin. 2011;21(3):163–7. https://doi.org/10.1016/j.enfcli.2011.02.005.
U.S. Department of Health and Human Services (HHS), The national commission for the protection of humans subjects of biomedical and behavioral research. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Belmont: U.S. Department of Health and Human Services. 1978. DHEW Publication N° (OS) 78–0012.