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In this qualitative study, we explored perspectives of patients in the intensive care unit (ICU) and their families on the Get to Know Me board (GTKMB). Of the 46 patients approached, 38 consented to participate. Of the 66 family members approached, 60 consented to participate. Most patients (26, 89%) and family members (52, 99%) expressed that GTKMB was important in recognizing patient's humanity. Most patients (20, 68%) and families (39, 74%) said that it helped to build a better relationship with the provider team. 60% of patients and families commented that the GTKMB was used as a platform by providers to interact with them. Up to 45 (85%) of the family members supported specific contents of the GTKMB. In structured interviews (11 patients, 7 family members), participants additionally commented on ways providers used the GTKMB to communicate, support patient's personhood, and on caveats in interacting with GTKMB. Critically ill patients and families found the GTKMB helpful in preserving personhood of patient, fostering communication, and building relationships with clinicians. [ABSTRACT FROM AUTHOR]

In educational consultation, responsibility for identifying and refining problems and modifying solutions remains with the consultee. Five steps of consultation are gaining entry, identifying the problem, engaging in action planning, evaluating, and disengaging. Consultant and consultee are in a nonhierarchical relationship. (SK)

BACKGROUND: Practice guidelines and research results emphasize the need for dyadic interventions targeting psychosocial outcomes such as depression, anxiety, social function, physical function, and health-related quality of life. Resilience interventions have been proposed as one strategy to influence these outcomes. OBJECTIVE: The objective of this observational pilot study was to determine the feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor (BT) admitted for comprehensive acute inpatient rehabilitation and/or their family caregivers. A secondary aim was to gather preliminary data to assess the effects of the program on quality of life, stress, anxiety, physical function, sleep disturbance, fatigue, resilience, dyadic coping, and caregiver role overload. METHODS: The Resilient Living program is a psychosocial intervention with a focus on building resilience skills. Feasibility and acceptability outcomes were assessed at the end of the study. Quantitative outcome measures were collected at baseline, 12 weeks, and 6 months post the intervention. RESULTS: Eight patients and eight caregivers completed the study. The intervention was feasible with this population. Participants found the intervention useful and appreciated the flexibility of an online program; however, finding time to engage in it was challenging. Recruitment of eligible patients with acquired brain disorders and their caregivers as a dyad was challenging. CONCLUSION: The study confirms prior research suggesting that interventions targeting resilience are feasible, but larger studies with more rigorous methods are needed to appreciate the influence of resilience interventions in persons with brain disorders and their caregivers. Further research is needed to identify the characteristics of those most likely to benefit from resilience interventions and the optimal timing of such interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acquired brain injury (BI) is associated with negative mental health outcomes for both people with BI, their caregivers (CG), and patient-CG dyads, which may be mitigated through increased resilience. However, little is known regarding the efficacy of resilience interventions focused on CGs of individuals with BI, as well as dyads, which may be instrumental for positive outcomes. OBJECTIVE: To systematically review the evidence of the efficacy of resilience interventions focused on CGs and/or dyads of individuals with BI. METHODS: A search of MEDLINE, Embase, APA PsycINFO, CINAHL with Full Text, Scopus, SCIE, and ESCI was conducted. Each title and abstract were screened by two authors independently. Each full text review, study data extraction, and study quality assessment was performed independently by two authors. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. RESULTS: Out of 11,959 articles retrieved, 347 full text articles were assessed for review and 18 met inclusion criteria for data extraction and quality assessment. Resilience interventions were stratified into 5 different categories based on the type of intervention. CONCLUSION: This systematic review suggests that dyadic/CG resilience interventions may improve mental health related outcomes, but conclusions were limited secondary to heterogenous outcomes and lack of a standardized resiliency construct. Future efforts are compulsory to create a standardized resiliency construct and associated outcomes focused on persons with BI, their CGs, and dyads. [ABSTRACT FROM AUTHOR]

Purpose Our aim was to explore reasons for physician variability in decisions to limit life support in the intensive care unit (ICU) utilizing qualitative methodology. Methods Single center study consisting of semi-structured interviews with experienced physicians and nurses. Seventeen intensivists from medical (n = 7), surgical (n = 5), and anesthesia (n = 5) critical care backgrounds, and ten nurses from medical (n = 5) and surgical (n = 5) ICU backgrounds were interviewed. Principles of grounded theory were used to analyze the interview transcripts. Results Eleven factors within four categories were identified that influenced physician variability in decisions to limit life support: (1) physician work environment-workload and competing priorities, shift changes and handoffs, and incorporation of nursing input; (2) physician experiences-of unexpected patient survival, and of limiting life support in physician's family; (3) physician attitudes-investment in a good surgical outcome, specialty perspective, values and beliefs; and (4) physician relationship with patient and family-hearing the patient's wishes firsthand, engagement in family communication, and family negotiation. Conclusions We identified several factors which physicians and nurses perceived were important sources of physician variability in decisions to limit life support. Ways to raise awareness and ameliorate the potentially adverse effects of factors such as workload, competing priorities, shift changes, and handoffs should be explored. Exposing intensivists to long term patient outcomes, formalizing nursing input, providing additional training, and emphasizing firsthand knowledge of patient wishes may improve decision making., Author(s): Michael E. Wilson [sup.1], Lori M. Rhudy [sup.2] [sup.3], Beth A. Ballinger [sup.4], Ann N. Tescher [sup.2], Brian W. Pickering [sup.5], Ognjen Gajic [sup.6] Author Affiliations: (1) grid.66875.3a, 000000040459167X, [...]

Background: Nursing handoff is a communication activity with a high risk for loss or omission of information. Efforts to improve handoffs include standardization of the processes and content of handoff communications. Objectives: To examine nurses' perspectives on the structure and organization of change-of-shift handoffs. Methods: A qualitative descriptive approach was used to conduct a secondary analysis of focus group data. Thirty-four nurses from 4 critical care units participated in focus groups. Results: Three themes emerged: handoff elements are defined by practice and culture; a clear, consistent, identified structure supports handoff; and personal preferences can disrupt handoff. Conclusions: A standardized approach to handoff based on unit and organizational needs will be more successful than a broad mandate of content and organization. Individual preference is prevalent and strongly influences the information conveyed and the structure of handoff communication. [ABSTRACT FROM AUTHOR]

The role of a radiology nurse is not clearly understood by patients or nursing colleagues. Following a radiology float nurse through a day in a complex radiology practice in a Magnet-designated facility illustrates how a radiology nurse must incorporate specialty education and training, clinical competence, and a professional nursing practice model to provide quality patient care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The purpose of this paper is to describe a model to guide nursing science in a clinical practice‐based setting. Exemplars are provided to highlight the application of this nursing research model, which can be applied to other clinical settings that aim to fill evidence gaps in the literature. Background: Nurse scientists are well positioned to develop new knowledge aimed at identifying global health solutions to multiple disparities. The generation and application of this knowledge are essential to inform and guide professional nursing practice. While a number of evidence‐based practice models exist to guide the integration of literature findings and other sources of evidence into practice, there is a need for additional models that serve as a guide and focus for the conduct of research in distinct scientific areas in practice‐based settings. Design: Model development and description. Methods: Mayo Clinic is a large, comprehensive healthcare system with a mission to address unmet patient needs through practice, research and education. PhD‐prepared nurse scientists engage in practice‐based research as an integral component of Mayo Clinic's mission. A practice‐based nursing research model was developed with the intent to advance nursing research in a clinical setting. Results: The components of the Mayo Clinic Nursing Research model include symptom science, self‐management science and caregiving science. The generation of nursing science is focused on addressing needs of patients with complex health conditions, inclusive of caregivers. Conclusions: While clinical settings provide rich opportunities for the conduct of research, priorities need to be established in which to focus scientific endeavours. The Mayo Clinic Nursing Research model may be applicable to nurses around the globe who are engaged in the generation of knowledge to guide practice. Relevance to Clinical Practice: The Mayo Clinic Nursing Research model can be used by nurse scientists embedded in healthcare settings to address clinically relevant questions, advance the generation of new nursing knowledge and ultimately improve the health and well‐being of patients and caregivers. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional, qualitative study was to determine unmet educational needs, preferences, and barriers experienced by individuals with chronic illness and their caregivers. A survey containing fixed-choice selections and open-ended questions was sent to persons with cancer and other chronic diseases who had been seen within a large national private health system. Between 20% and 25% of participants had difficulty obtaining health care information and/or felt overwhelmed with managing their condition. Coping, managing symptoms, and making treatment decisions were areas of need in both patients and caregivers. Preferences for receiving information were diverse. Existing methods of communication including secure Web sites where patients can access their medical records posed significant challenges. [ABSTRACT FROM AUTHOR]

B Introduction: b The common practice in critical care of referring to patients by their chief complaint or room number combined with high workload, burnout, prioritization of the medical aspect of illness, limited family presence and even the new normal of masking one's face may inadvertently result in patient dehumanization. Most patients (26, 89%) and family members (52, 99%) expressed that GTKM board was important in recognizing patient's humanity. [Extracted from the article]

Background: Delay in seeking treatment for symptoms of atrial fibrillation (AF) at onset results in a missed opportunity for vital early treatment of AF which is important for reducing stroke, tachycardia induced heart failure, and treatment-resistant AF. Little is known about factors that contribute to treatment-seeking delay for symptoms of AF. Purpose: The purpose of this study was to identify factors associated with treatment-seeking delay for symptoms of AF before diagnosis. Methods: For this descriptive study, 150 participants with recently detected AF completed structured interviews to collect data about symptoms, symptom characteristics, symptom representation regarding cause, seriousness, controllability of symptoms, responses to symptoms before diagnosis, and time from symptom onset to treatment-seeking. Chi-square analysis was used to identify factors associated with delay (>1 week) versus no delay (⩽1 week) in treatment-seeking after symptom onset. Results: Participants were 51% female (n=76) with a mean age of 66.5 (standard deviation (SD)±11.1) years. A majority (70%, n=105) delayed treatment-seeking. Factors associated with delay included experiencing fatigue, dyspnea, intermittent symptoms, attributing symptoms to deconditioning, overwork, inadequate sleep, and perceiving symptoms as not very serious and amenable to self-management. Responses such as a wait and see approach, working through symptoms, reporting no fear of symptoms, or attempting to ignore symptoms were associated with delay. Conclusion: Experiencing fatigue, dyspnea and intermittent symptoms produced symptom representations and emotional and behavioral responses associated with treatment-seeking delay. There is a critical need to develop and test educational interventions to increase awareness of the spectrum and characteristics of AF symptoms and appropriate treatment-seeking behaviors. [ABSTRACT FROM AUTHOR]

Objective. Patients with fibromyalgia report periods of symptom exacerbation, colloquially referred to as "flares" and despite clinical observation of flares, no research has purposefully evaluated the presence and characteristics of flares in fibromyalgia. The purpose of this qualitative study was to describe fibromyalgia flares in a sample of patients with fibromyalgia. Methods. Using seven open-ended questions, patients were asked to describe how they perceived fibromyalgia flares and triggers and alleviating factors associated with flares. Patients were also asked to describe how a flare differs from their typical fibromyalgia symptoms and how they cope with fibromyalgia flares. Content analysis was used to analyze the text. Results. A total of 44 participants completed the survey. Responses to the seven open-ended questions revealed three main content areas: causes of flares, flare symptoms, and dealing with a flare. Participants identified stress, overdoing it, poor sleep, and weather changes as primary causes of flares. Symptoms characteristic of flares included flu-like body aches/exhaustion, pain, fatigue, and variety of other symptoms. Participants reported using medical treatments, rest, activity and stress avoidance, and waiting it out to cope with flares. Conclusions. Our results demonstrate that periods of symptom exacerbation (i.e., flares) are commonly experienced by patients with fibromyalgia and symptoms of flares can be differentiated from every day or typical symptoms of fibromyalgia. Our study is the first of its kind to qualitatively explore characteristics, causes, and management strategies of fibromyalgia flares. Future studies are needed to quantitatively characterize fibromyalgia flares and evaluate mechanisms of flares. [ABSTRACT FROM AUTHOR]

Early treatment-seeking for symptoms of atrial fibrillation (AF) is critical to avert AF-related stroke and heart failure, but early treatment is hindered if symptoms are not accurately interpreted. The purpose of this research was to describe symptom representation and treatment-seeking responses prior to diagnosis of AF. For this descriptive study, 150 participants were surveyed to describe the type and temporality of symptoms, perceptions regarding the cause, seriousness, controllability of symptoms, and responses to symptoms prior to diagnosis. Participants’ mean age was 66.5 years, and 51% were female. Participants perceived symptoms as having nondisease-based causes, as not very serious, and as amenable to self-management. The majority took a wait and see response with 69% waiting more than 1 week after symptom onset to seek treatment. Lack of recognition of the seriousness of symptoms of AF and delayed treatment put patients at risk of poorer outcomes. [ABSTRACT FROM AUTHOR]

Purpose To develop and test a decision support tool that identifies patients who would benefit from early consult with discharge planners. Design and Methods A predictive, correlational design was used with parents/guardians of children (1 month to 18 years; N = 197). Data were collected by interviews and record reviews. Expert consensus determined referral to discharge planning. Results Mean age was 8.7 years; mean length of stay was 7.5 days. Forty percent ( n = 79) were identified for early referral. The variable 'substantial post-acute care needs' had the strongest association with expert consensus (internally validated AUC = 0.79). Practice Implications Findings from this study provide preliminary evidence for a decision support tool to improve the discharge planning process by reducing individual decision-making variability through systematic matching of patient needs to service delivery. [ABSTRACT FROM AUTHOR]

Little is known about the transition between hospital dismissal and onset of hospice services from the patient/family perspective. The specific aim of this phenomenological study was to describe the lived experience of patients and families transitioning from hospital to home hospice care. Nineteen patient and family units transitioning from hospital to home hospice care participated in this study. They photographed objects, people, and events during the hours or day(s) of this transition. Semistructured interviews occurred as soon as possible following the first home hospice visit. Data collection and analysis were concurrent, using validated transcripts and field notes. Patients and families experienced unexpected disruption during this transition, because of lack of clarity regarding hospice, their scramble to get ready, and a sense of open house once they arrived home. In this study, the transition experience extended beyond initiation of hospice care, with uncertainty about what hospice care would mean and disruptions in the preconceived expectations about hospice. Health professionals define the transition period as an 'event,' and the patients/families experience it as a 'process.' Implications for practice, education, and research are provided. [ABSTRACT FROM AUTHOR]

Cancer diagnosis and treatment are universally distressing events that may cause or exacerbate symptoms of post-traumatic stress. Accelerated Resolution Therapy (ART) is a mind-body therapy that has demonstrated success is treating trauma resulting from combat experiences, sexual assault, and complicated grief. ART has not yet been tested in the setting of cancer distress with symptoms of post-traumatic stress. The purpose of this qualitative study was to explore contextual elements of the cancer experience that were consistently distressing and/or psychologically traumatic, as well as perceptions of ART for the treatment of cancer distress. Semi-structured interviews were conducted by phone four weeks following ART, audio-recorded, and transcribed verbatim. Purposive sampling techniques were used, and participants were recruited from a National Cancer Institute (NCI)-designated comprehensive care center. Eligibility included: ≥18 years old, English speaking, recent or current cancer treatment, a mean score of at least 1.1 on the Cancer and Treatment Distress (CTxD) scale, a minimum score of 3 on the Primary Care-Post Traumatic Stress Disorder (PC-PTSD) scale. Interviews were conducted until data saturation was met. A thematic analysis was conducted using NVIVO 11.0 software. The majority of participants (n=13) were female (84.6%), Caucasian (76.9%), and non-Hispanic (76.9%). The mean age was 55.2 years. The majority had either a stage III (23.8%) or IV (46.2%) solid tumor and had received previous chemotherapy (84.6%). Participants described a variety of traumatic events earlier in life that influenced their cancer experience. For others, the cancer diagnosis was the underlying source of distress. Participants described various ways in which ART helped them process their emotions and restored a sense of calm, inner peace, and better insight and control over their reactions to stressful events. All participants endorsed early incorporation of ART or coping strategies into cancer treatment. Interventions such as ART that can address previous trauma and current distress are needed to address the psychosocial needs of oncology patients. ART may be particularly helpful when individuals enter cancer treatment with unresolved past trauma. Recognition and treatment of emotional distress by members of the oncology team was viewed very positively by participants. [ABSTRACT FROM AUTHOR]

The study aims were to describe the number, type, and source of interruptions and ICU nurses' perceptions about interruptions during change-of-shift handoff. Consequently, the nurse receiving was more likely (57%) than the nurse giving (44%) handoff to identify interruptions as helpful to nursing care. The remaining interruptions included phone/pager calls, other nurses, consultant physicians, nursing assistants, and other care providers. [Extracted from the article]