Physicians' and nurses' interdisciplinary strategies towards critically ill ICU patients' families - a qualitative study

Stipendiaten har fullført sitt PhD-arbeid med tre artikler, og en fjerde er under arbeid. Kappen er under skriving og forventes innlevert i løpet av kort tid. Data til studien "Physicians’ and nurses’ interdisciplinary strategies towards critically ill ICU patients’ families – a qualitative study" er generert gjennom feltforskning ved tre universitetssykehus (tilsammen 270 timer) og ved fokusgruppe-intervju med intensivleger og intensivsykepleiere ved intensivavdeling ved tre universitetssykehus og et sentralsykehus. I tillegg ble det gjennomført noen intervju med kirurger og medisinere fra avdelinger intensivpasienter tilhører. Den første publiserte studien rapporterer forhold vedrørende overføring av informasjon (rapportering) om pårørende: Nygaard, A. M., Haugdahl, H. S., Brinchmann, B. S., & Lind, R. (2020). Information concerning ICU patients’ families in the handover—The clinicians’«game of whispers»: A qualitative study. Journal of Clinical Nursing, 29(19-20), 3822-3834.The aim of this study was to explore nurses’ and physicians´ transfer of information concerning ICU patients’ family members during handovers. The findings indicate challenges related to appropriate and high-quality transmission of family-related information between clinicians. Such information was mainly communicated orally. Oral handovers are essential in terms of clinicians’ need to elaborate on the information and update each other, including details about the family. At the same time, oral transmission involved a high risk of information being altered or lost as in a “game of whispers.” In addition, the study showed that written documentation about the ICU patient's family was inadequate and poorly structured. Recommendations for clinical practice and policy: It appears that few previous studies have emphasised how information about patients’ family is transferred between ICU clinicians. The findings of this study suggest a need for increased awareness in practice and research of appropriate and reliable information transfer in the ICU context. User-friendly handover tools and patient records that include information on patients’ family members should be developed. Studie 2 (In second peer-review-process): Interprofessional care for the ICU patient’s family: Solitary teamwork. The aim of this study was to explore how ICU teams’ interprofessional family care was reflected in their daily work. The study aim was to explore how interprofessional family care is reflected in ICU teams’ daily work. With a constructivist grounded theory approach, ‘solitary teamworking’ emerged as the core category explaining the contrasts in interprofessional family care; ICU physicians and nurses alternate between working alone and as a team. Family care is experienced as engaging and rewarding, but emotionally challenging, both in contact with the family and in cooperating with colleagues and management. The findings indicate that unit managers must facilitate a culture supporting and prioritising family care, where family members are included as an active part of the ICU team and interprofessional dialogue is emphasised. Studie 3: Anne Mette Nygaard, Hege Selnes Haugdahl, Hilde Laholt, Berit Støre Brinchmann, Ranveig Lind: A narrative view of nurses' and physicians interaction with ICU patients' families (Accepted August 30th 2021 in Nursing Ethics, awaiting published in issue). Quality of ICU family care depends on nurses’ and physicians’ attitudes, behaviour and personality traits. Three main themes were identified: being attentive, an active approach and degree of tolerance.This study shows that attentive, active and tolerant clinicians represent a culture of ethical care that gives families greater freedom of action and active participation in patient care. Clinicians must not bear sole responsibility for this culture; it must have a firm basis in the hospital and ICU and be established through training, interprofessional reflection and support of clinicians. Studien har med sin brede tilnærming (omfattende feltforskning, fokusgrupper og individuelle intervju) bragt fram et mer helhetlig bilde av pårørendearbeid i intensivavdelinger, og har avdekket strukturelle svakheter i organiseringen av dette viktige arbeidet. Studien viser at arbeidet i liten grad er strategisk og er overlatt til den enkelte sykepleiere og lege. Det arbeides ofte godt med pårørende, men praksis blir mer tilfeldig enn planlagt, og derved avhengig av det enkelte helsepersonell. Arbeidet med pårørende er for en stor del ikke kunnskapsbasert og er i liten grad systematisk, og det dokumenteres lite om dette i pasientjournalen. To av de inkluderte avdelinger har stramme besøkstider, stikk i strid med kunnskapsbaserte anbefalinger. Pårørendearbeidet bør være mer eksplisitt i fokus. Det kan bli mer strategisk og ledelsesforankret, for eksempel ved å initiere bruk av guidelines for arbeidet, for samtaler med pårørende og at pårørende inkluderes og får være tilstede i større grad.