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The Hospital and ICU Environment The family perspective environment... · The family perspective...
Transcript of The Hospital and ICU Environment The family perspective environment... · The family perspective...
The Hospital and ICU Environment
The family perspective
Sangeeta Mehta MD
@geetamehta0
Sinai Health System & University of Toronto
CCCF November 11, 2019
Disclosures
• I have nothing to disclose
• Within the last 12 months I have not had any type of
financial arrangement or affiliation with commercial
interests related to the content of this continuing education
activity that requires disclosure
Background
• Family members of critically ill patients spend prolonged durations of time in the hospital, waiting room and ICU
• Flexible 24/7 visitation more common
• Their practical and material needs within the hospital and waiting room are not known
• They can provide insight on improving patient comfort in the ICU
Crit Care Med 2002
- 9 ICUS at tertiary hospital- 449 family members- Family Satisfaction with Care in the ICU instrument
Objectives
• What are the perspectives of visitors to the ICU regarding the physical environment of the hospital, waiting room, and patient ICU rooms?
• What do they value for themselves and for patients?
Methods
• Formal survey development: Literature search, item generation, questionnaire development and testing
• Inter-professional collaboration, patients, and visitors (family members and friends)
• 4 University affiliated ICUs: Sinai Health, St Michael’s, Niagara Health, Juravinski
• Visitors approached in waiting rooms and provided with anonymous questionnaire
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Hospital environment
Signage
Parking
Info on food & accommodation
Food preparation facilities
Sleeping in the hospital
Shower facilities
Religious/spiritual needs
Childcare
Interpreters
Waiting room
Furniture, art, paint, plants
Private space
Natural light/air
Informational material
Lockers
Visitor bathroom
Visitation
Television, computer, wifi
Reading material
Patient ICU room
Sleeping facility for family
Chair
Communication tool
Pet
Privacy
Natural light/air
TV/music/computer
Dimming of lights
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Demographics
• 163 questionnaires completed
• 40% M, 59% F
• Person of colour / visible minority 20%
• First language: English 78%
Indian (9), European (7), French (3), Mandarin/Cantonese (4), Tagalog (2), Farsi (2), Persian (2), Amharic (2)
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Patient Age
20-40
41-60
61-80
81-90+
Visitor's Age
<20
20-40
41-60
61-80
81-90+
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Relationship to Patient
Spouse/Partner
Child
Sibling
Parent
Friend
Other
Distance from Hospital
<30km
31-50km
51-100km
>100km
Distance from Hospital
<30km
31-50km
51-100km
>100km
Have you slept in the waiting room?
YESN=46 28%
NON=11672%
# nights: 1 2 3 4
N 17 14 6 3
Range: 1-7
nights
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Extremely important
Very important82% 79% 79% 77%
56%50%
45%
61%
41%
Lower priority – Hospital environment
• Childcare
• Information about religious services
17
93%
80% 78%
71%65%
53%50%
85% 83%
Extremely important
Very important
Lower priority – ICU waiting room
• Religious symbols
• Paint colour / Art
• Plants and greenery
• Telephone
• Food-free waiting room
• Technology-free zone
Extremely important
Very important
93%
59% 57%62%63%
75% 76%73% 71%
Lower priority – Patient room
• Religious symbols
• Sleeping in the same bed
• Pet visitation
• Paint colour and Art
• TV / ipad / music
Textual comments
• More volunteers, and instruction
• Showers, sleeping facilities, more washrooms
• Regular cleaning of visitors’ facilities
• Phone charging stations / more outlets
• Sink in waiting room
• Privacy for nursing
• Eating area
• Surveyed visitors living > 1 hour drive from trauma center
• Daily median travel time >3 hours; daily cost $40/day
• Issues needing improvement
• Parking, Accommodation nearby
• Being introduced to unit/ward when they first come, Getting info from HCP
• Waiting room
• Important findings
• Some visitors slept in their cars
• Loved one’s illness affected their ability to work; loss of income
• Arrangements for care of dependent children, elderly, pets
• General Sleep Disturbance Scale (GSDS), Beck Anxiety Inventory (BAI), Lee’s Numerical Rating System for Fatigue (NRS-F)
• Family members slept…
home (57% nights) waiting room (22% nights) hotel (18% nights)
• Why did they sleep in hospital?- home too far from hospital (30%)
- too anxious to leave hospital (19%)
• 27% (N=25) spent ≥ 1 night sleeping in hospital• significantly higher GSDS, BAI and NRS-F scores than visitors who never overnighted
J Pediatric Psychology 2008
Telephone survey
135 Canadian / US pediatric hospitals
J for Healthcare Quality 2013
Pleasant
Privacy
NoiseLightsStimulation
Olausson, Intensive and Crit Care Nursing 2012
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Critical Care Patient Journey Map
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What do visitors to ICU prioritize…
For patients
•Chairs
•Natural light, fresh air
•Dim lighting at night
•White board
•Privacy
For themselves
•Open visitation
•Signage
•Parking
•Shower
•To sleep nearby or in the pt room
•Water
•Comfortable furniture
•Wifi/charging station
With thanks to…
Sinai HealthSumesh Shah
Fernando Martinez Guasch
Nanki Ahluwalia
Uroosa Khan
Jocelyn Lau
Juravinski HospitalBram Rochwerg
Tina Millen
Alexa Bersenas
Niagara HealthJennifer Tsang
Mercedes Camargo Penuela
St Michael’s HospitalKaren Burns
Sandi Gobin
An ICU is a place to live - not just survive.
Woodward JA. RN 1978;41:62
@geetamehta0
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J of Pediatric Psychology 2008;33:292-297
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Family needsPractical needs generally concern the family member’s feeling of comfort, in which both material and non-material matters can play a role.
In the category of the non-material needs, flexible visiting hours are at the top, followed by help with financial or family problems and explanations of what family members can do at the bedside of the patient and how they can contribute to the patient’s care.
Material things include a waiting room with a telephone, comfortable furniture, blankets and a place to lie down, a cafeteria and a toilet and a bathroom near the ICU. The priorities assigned to these material comfort needs vary.
That family members find their own material needs least important shows, once again, that they give absolute priority to everything that concerns the patient.
Hospitals give low priority to meeting the practical needs of family members who, in turn, express the least amount of satisfaction with it
What are the needs of visitors?
•Open visiting policy
•Comfortable waiting room close to ICU, with telephone and internet
•Signage
•Overnight accommodations
•Bathroom, shower
•Food