Interventions to promote family member involvement in adult critical care settings: a systematic review

Abstract

ObjectiveTo identify, appraise and synthesise evidence of interventions designed to promote family member involvement in adult critical care units; and to develop a working typology of interventions for use by health professionals and family members.DesignMixed-method systematic review.Data sourcesBibliographic databases were searched without date restriction up to June 2019: MEDLINE, EMBASE and CINAHL; the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Back issues of leading critical care and patient experience journals were manually searched, as were the reference lists of included studies. All evaluation studies of relevant intervention activities were included; all research designs and outcome measures were eligible. Due to heterogeneity in interventions, designs and outcome measures, the synthesis followed a narrative approach. Service users met with the research team termly.ResultsOut of 4962 possible citations, a total of 20 studies were included. The overall evidence base was assessed as moderate to weak. Six categories of interventions were identified: environmental unit changes (n=2), web-based support (n=4), discussion-based support (n=6), multicomponent support (n=4), participation in rounds (n=3) and participation in physical care (n=1). Clinical and methodological heterogeneity across studies hindered meta-analysis, hence a narrative synthesis was pursued. Six main outcomes were identified, grouped under two categories: (i) involvement outcomes: communication (mean difference ranged from 6.39 to 8.83), decision-making (mean difference ranged from −0.8 to 5.85), satisfaction (mean difference ranged from 0.15 to 2.48); and (ii) health outcomes: family trauma (mean difference ranged from −7.12 to 0.9), family well-being (mean difference ranged from −0.7 to −4), patient outcomes (relative risk ranged from 1.27 to 4.91). The findings from the qualitative studies were thematically analysed to identify features of the interventions that participants perceived to influence effectiveness. Synthesised into five overarching categories (practicality, development, interaction, reflexivity and bridging), these can serve as principles to inform the future design and development of more refined family member involvement interventions.ConclusionsFuture interventions should be developed with much closer family member input and designed by considering the key features we identified. We call for future interventions to be multilayered and allow for a greater or lesser level, and different kinds, of involvement for family members. Choice of intervention should be informed by a baseline diagnostic of family members’ needs, readiness and preparedness for involvement.PROSPERO registrationCRD42018086325.

Visitor Behaviors Can Influence the Risk of Patient Harm: An Analysis of Patient Safety Reports From 92 Hospitals

“…Consistent with previous studies, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] our results revealed that visitor behavior was frequently associated with a decreased risk of patient harm. For example, we found that visitor communication with staff was most frequently reported as decreasing risk of harm and was distributed across all seven event types.…”

“…Previous research has demonstrated the positive influence of visitors on patient outcomes. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] For example, studies have found that visitors can successfully participate in patient safety interventions, such as fall prevention 15,16 and rapid response activation. 9 The potential for visitors to contribute to an increased risk of patient harm is less understood.…”

Jordanian Patients’ Family Members Need Perceptions in the Critical Care Settings: Nurses’ Perspectives versus Family Members’ Perspectives in the Context of Health Informatics

“…Consequently, the family might not be able to support their patients during these critical moments. Recommendation has been made in this regard as future interventions, and family involvement decision is to be at different levels of different kinds based on family choice, readiness, and preparedness for that [ 35 ].…”

Actionable processes of care important to patients and family who experienced a prolonged intensive care unit stay: Qualitative interview study

“…Proactive family communication, enabling flexible visiting and bedside presence, as well as involvement in care and decision making particularly in terms of long‐term planning were actionable processes identified during our analyses. Family members are integral to ensuring the wishes of patients inform decision making (Azoulay et al, 2014) to patient's recovery (Xyrichis et al, 2021) but also need psychological support and care from the ICU team (Dale et al, 2020; Herridge et al, 2016). Importantly, in their ethnographic work, Rak and colleagues (Rak et al, 2020) found engaged family members was one of the characteristics associated with high performing Long‐Term Acute Care Hospital.…”