Under the radar: Contributions of the SUPPORT nurses

Murphy, Patricia A.; Price, David M.; Stevens, Marguerite; Lynn, Joanne; Kathryn, Erica

doi:10.1067/mno.2001.115444

Cited by 21 publications

(20 citation statements)

References 4 publications

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“…17 The SUPPORT nurses often provided extensive communication, education and emotional support to patients and families, the impact of which may not have been measured by the planned outcomes. 18 Failure to fully integrate into systems of care may have also reduced the impact of the intervention. 19 …”

Section: Introductionmentioning

confidence: 99%

The Family Navigator: A Pilot Intervention to Support Intensive Care Unit Family Surrogates

Torke

Wocial

Johns

et al. 2016

American Journal of Critical Care

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Background Although communication problems between family surrogates and intensive care unit (ICU) clinicians have been documented, there are few effective interventions. Nurses have the potential to play an expanded role in ICU communication and decision making. Objectives To conduct a pilot randomized controlled trial of the Family Navigator (FN), a distinct nursing role to address family members’ unmet communication needs early in an ICU stay. Methods An inter-disciplinary team developed the FN protocol. A randomized controlled pilot intervention trial of the FN was performed in a tertiary referral hospital ICU to test the feasibility and acceptability of the intervention. The intervention addressed informational and emotional communication needs through daily contact using structured clinical updates, emotional and informational support modules, family meeting support and follow-up phone calls. Results Twenty-six surrogate/patient pairs (13 per study arm) were enrolled. Surrogates randomized to the intervention had contact with the FN 90% or more of eligible patient days. All surrogates agreed or strongly agreed that they would recommend the FN to other families. Open-ended comments from both surrogates and clinicians were uniformly positive. For both groups, 100% of baseline data collection interviews and 81% of 6–8 week follow-up interviews were completed. Conclusions A fully integrated nurse empowered to facilitate decision making is a feasible intervention in the ICU setting. It is well-received by ICU families and staff. A larger randomized controlled trial is needed to demonstrate an impact on important outcomes, such as surrogate well-being and decision quality.

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Section: Introductionmentioning

confidence: 99%

The Family Navigator: A Pilot Intervention to Support Intensive Care Unit Family Surrogates

Torke

Wocial

Johns

et al. 2016

American Journal of Critical Care

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“…It was unclear whether the discussion was intended for significant others, health care providers, or both. Several of the nurses who provided the SUPPORT intervention identified effective communication as a precursor to end-of-life decision making by the patient and family (Murphy, Price, Stevens, Lynn, & Kathryn, 2001). More attention needs to be given to supporting individuals to communicate end-of-life preferences.…”

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confidence: 94%

Communicating End-of-Life Preferences

et al. 2003

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The purpose of this survey was to explore how adults communicate their end-of-life preferences. Face-to-face interviews were conducted with 119 community-dwelling adults who had previously engaged in conversations about their end-of-life preferences. Factors that made it easier to initiate the discussion included having personal experience with illness or death (24.4%), being straightforward (24.4%), or having someone else facilitate the discussion (11.8%). Most described vague end-of-life preferences such as not wanting any machines (41.2%) or heroics (34.5%). Although 22.7% reported using a living will to make their preferences clear, only 5.9% mentioned repeating or reinforcing their preferences. In all, 21% had discussed their end-of-life preferences with their physicians. These findings show discussions about end-of-life preferences frequently lack the clarity and detail needed by significant others and health care providers to honor the preferences. Routine dialogue with health care providers and significant others about end-of-life preferences might provide greater clarity and comfort.

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“…First, quality improvement studies have shown that patient satisfaction with health care is generally very high in spite of the presence of unmanaged symptoms such as pain (Gordon et al, 2002). Second, in tests of interventions it is common to see data indicating that patients' like an intervention even though the effects of that intervention on the intended outcomes are negligible (e.g., see Murphy, Price, Stevens, Lynn & Kathryn, 2001). These two lines of work suggest that satisfaction measures tap patients' affective/evaluative reactions to the interpersonal elements of a nursing intervention; that is, measures of satisfaction tap non-specific effects.…”

Section: Examplesmentioning

confidence: 99%

Nonspecific Effects in Psychoeducational Intervention Research

et al. 2009

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Randomized clinical trials support the efficacy of a wide range of psycho-educational interventions. However, the mechanisms through which these interventions improve outcomes are not always clear. At times, the theoretically specified factors within interventions have been shown to have specific effects on patient outcomes. But it has also been argued that other factors not identified in the intervention theory (e.g. "non-specific" factors such as patient expectations and therapeutic patientclinician alliances) have powerful "non-specific" effects that account for most, if not all, of the observed efficacy of psycho-educational interventions. This paper describes important concepts in this debate and discusses key issues in distinguishing between specific and non-specific effects of psycho-educational nursing interventions. Four examples are used to illustrate potential methods of identifying and controlling for non-specific effects in clinical intervention trials. KeywordsNon-specific effects; placebo effect; intervention methods In a recent editorial, Conn (2008) called for increased efforts to publish reports of studies that quantitatively assess effects of nursing interventions. She emphasized the persistent gap between "real world nursing practice and available empirical evidence about interventions" (p. 913). One critical aspect of such research is identifying an intervention's active components so they can be adequately communicated, transferred, and implemented across populations and settings. In the "real world", nurses do not have time to deliver intervention components that fail to contribute to beneficial outcomes. Moreover, they need to know the specific factors that must be included to reproduce improvements in outcome. It is the role of nurse investigators to determine whether or not the theoretically active components of an intervention result in specific effects on patient outcomes or whether other factors may have influenced outcomes (resulting in non-specific effects). A long history of opinion exists around specific and nonspecific treatment effects in the medical and psychology literatures, but this important topic has received far less attention in nursing. The purpose of this paper is to review key aspects of the historical debate, to discuss the implications of these arguments for tests of psychoeducational interventions in nursing, and to provide examples of approaches that can be used by nurse investigators to account for specific and non-specific treatment effects. Basic ConceptsIn testing health-related interventions (psycho-educational or otherwise), researchers develop their treatments to include theoretically-derived "specific" factors. That is, they include key elements with theoretically derived actions that are expected to produce the desired change in health outcomes. For example, Johnson's self-regulation theory suggests that providing patients with education including sensory preparation prior to a noxious medical procedure will help them make sense of their experien...

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Under the radar: Contributions of the SUPPORT nurses

Cited by 21 publications

References 4 publications

The Family Navigator: A Pilot Intervention to Support Intensive Care Unit Family Surrogates

The Family Navigator: A Pilot Intervention to Support Intensive Care Unit Family Surrogates

Communicating End-of-Life Preferences

Nonspecific Effects in Psychoeducational Intervention Research

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