Family Support Programme for ICU Patient Relatives

Family Support Programme for ICU Patient Relatives Constantin Vintilescu From DNP Online Community Davidson, E., Daly, J., Brady, R. Higgins, P. (2010). Facilitated Sensemaking A Feasibility Study for the Provision of a Family Support Program in the Intensive Care Unit. Critical Care Nurse Journal 33 (2) 177-189. Introduction / Purpose Evidence has shown that family members of Intensive Care Unit (ICU) patients develop anxiety, depression, or post-traumatic stress syndrome -like symptoms. Paparrigopoulos (2006), Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2006) and the Society of Critical Care Medicine recommend family-centered care, but few studies demonstrate successful interventions to â€Å"decrease the ad ­verse psychological effect of critical illness on the family.â€Å" (Azoulay, 2005) This project served to examine the feasibility of such interven ­tions, and as a pilot program to investigate research procedures before the design of a controlled trial. Derived from business leadership models, â€Å"Facilitated Sensemaking,† provided the theoretical framework for the interventions: family members experience a disruption in their lives when a loved one is admitted to the ICU; they adjust with a compensatory process that may be influenced by nursing interventions. Methods The ‘Family Support Pro ­gram’ was developed consisting of personalized instructions delivered a clinical nurse specialist, and a family visiting kit in zip-locked plastic bag consisting of: a workbook including program introduction and instructions, cognitive recovery activities, activities to perform at the bedside including passive range of motion exercises, and personal care items. The program was offered to 30 consecutive families in a 32 bed â€Å"mixed-use ICU. All participants were English-speaking adult family members of mechanically ventilated adult ICU patients. To evaluate feasibility, data was collected on program acceptance, time of personal instruction, use of items in the family visiting kit, and family perception of program usefulness. In piloting the research procedure: a Family Sup ­port Program evaluation, and adapted Critical Care Family Needs Inventory (aCCFNI) was administered and psychometric properties of the instrument the reliability and validity of the questioner and scoring method were assessed. A convenience sample is a study of subjects taken from a group that is conveniently accessible to a researcher. One advantage of this is that it is easy to access, requiring little effort and time. This sampling method suffers from a major disadvantage in that it is not an accurate representation of the population, which can skew results quite radically. Use of a convenience sample is quite popular and prevalent, however, and it can be valid under certain conditions. Biases and Flaws Any number of biases can occur in a convenience sample. By selecting from a specific population such as students enrolled in Sociology 101, people visiting a mall between 10:00 am and 2:00 pm on Saturdays, or library patrons, the study inadvertently excludes a great deal of the population. Choosing only students in a particular classroom at a certain university can easily exclude certain portions of the general populace, such as children or those without the financial means to attend the school. Such exclusions are not always a problem. For example, a study on library patrons could easily take a convenience sample of people at a certain library and generalize the results. On the other hand, a study on social attitudes toward people with disabilities should not use only the students in a sociology class, which does not necessarily represent an accurate cross-section of the population. This inability to accurately generalize the results of such a group makes it ineffective for many studies. Researchers who want more valid results typically take a probability sample, which attempts to get an accurate representation of the population. It is not generally possible to study everyone, but it is possible to randomly assign people to a study with an eye toward retaining a balance of characteristics seen in the population in general. For example, organizations that conduct political polling usually try to draw on a large database of people and select subjects randomly. This randomization increases the chances of a more accurate pool forming to produce results that can be better generalized. If a convenience sample is used, researchers typically disclose this fact. Good research usually includes a detailed overview of the sampling techniques used, so that people reading about it have a better understanding of how it was conducted. When revealing that a convenience sample was used, the researcher may also present justifications for its use and defend its accuracy. Evaluation / Analysis Standard statistical methods were applied using SPSS. Each aCCFNI item was ranked in order of importance using a weighted average analysis to measure â€Å"the importance of the need and how well that need was met† (Davidson 2010). The Family Sup ­port Program evaluation questioner was in the same way analyzed with descriptive statistics. Results Of the thirty family members approached for the Family Support Program, all consented to participate. 22 surveys were returned. Quantitative analyses of the aCCFNI results determine all 45 needs had some importance. Likewise, all items offered within the family visiting kits were found useful to some fam ­ily members. 42 Referrals to ancillary services were made for the 30 family members. Discussion / Conclusion Like previous research, this study demonstrated the importance of each of the 45-aCCFNI needs. A list of top 10 needs was also identified and corresponds with work by other researchers. Several non-generalizable opportunities for unit-specific performance improvement, including parking and other transportation related areas of stress were identified. 27% of family members who participated in the study did not to complete the surveys. The authors speculate that, â€Å"the early critical care period may be too stressful to concentrate on writing.† Only two family members were observed writing in the provided workbook even though the workbook was reported as helpful on the program evaluation questioner. The authors point-out similar phenomenon demonstrated in the literature (Kloos 2008). The small sample size was identified as a study limitation. Results of this study are â€Å"also limited to English-speaking adult family members of mechanically ventilated patients† (Davidson 2010). The contents of the family visiting kits were re ­fined with feedback received from family members during the study. It was suggested to build a ‘family supply cart’ to wheeled around the unit and offer supplies to family members. Operational issues During the study, many unit-specific issues arose regarding current practice and were for ­warded to the leadership team for action. For example, while screening patients for inclu ­sion into the study, the investigator discovered that many patients did not have family mem ­bers or visitors. A visiting ministry to meet the social needs of those patients has been suggested. Nurses and families alike were unaware of the hospital’s family room in the medical li ­brary equipped with an Internet-connected computer and handy hot-linked Web sites as well as novels. Because of study refer ­rals, the librarian reported an increased use in the family room (M. Robinson, personal oral communication, September 30, 2007). An informational sheet of family-friendly med ­ical information sites was prepared for in ­clusion in the visiting kit and later use. A note card explaining library services was de ­veloped, printed, and stocked in the waiting areas. As found in studies by Lautrette et al,31 Melnyk et al,14 Jones et al,13 and Kloos and Daly,33 family members appreciate supportive interventions that are multimodal in nature, both verbal and written. In this study, families also self-reported and it was observed that tac ­tile interventions using common household items for hands-on bedside activities were a welcome addition to the family support services. CONCLUSION The Family Support Program based on the model of facilitated sensemaking is not only feasible but also helpful to family members of mechanically vented, adult ICU patients. The demonstrated reliability of the aCCFNI supports its continued use in identifying im ­portant needs and evaluating whether those needs are met for families of ICU patients. An overall score weighting importance and needs-met for each item aided in ranking op ­portunities for improvement. Future research is warranted to continue evaluation of the Fa ­cilitated Sensemaking theory and measure ef ­fect of these interventions on outcomes (eg, anxiety, depression, symptoms suggestive of risk for posttraumatic stress). Inclusion of this nursing intervention is warranted to assist family members in communicating with the patient as part of the list of bedside activi ­ties. Future study design should be expanded to other cultures or patient groups. Educa ­tional programs targeted to provide instruc ­tion f or nurses on how to include family mem ­bers into daily practice are also warranted. The time the lead investigator spent per fam ­ily in supportive interactions appeared rea ­sonable for inclusion into the bedside nurse’s practice. Feasibility was further supported in that family members accepted and used the inter ­ventions that were based on concepts of the Facilitated Sensemaking model. Information to assist with decoding by explaining equip ­ment, alarms, and surroundings was notably accepted. Instructions for interacting with or assisting ICU patients were appreciated. The provision of personal care supplies was found to be most helpful and useful. Verbal instruc ­tions and hands-on activities were preferred over journaling activities. References Azoulay, E., Pochard, F., Kentish-Barnes, N. et al. (2005). Risk of post-traumatic stress symptoms in family members of intensive care unit patients. American Journal of Respiratory and Critical Care Medicine .171 (9): 987-994 Paparrigopoulos, T., Melissaki, A., Efthymiou, A. et al.(2006).Short-term psychological impact on family members of intensive care unit patients. Journal of Psychosomatic Research.61 (5):719-722

When I Grow Up I’M Going to Be

† When I grow up I'm going to be†¦ † How often you must have said the words above when you were younger! You wanted to be a motion-picture star, an acrobat, a fireman, or a sailor. Now that you are older you realize that choosing a vocation is not a simple matter. In fact it is one of the most difficult and most important decisions of your life. Upon it depends your health, happiness, and usefulness. Soon you will be one of many boys and girls who each year go out in search of jobs.Start preparing for your lifework now while you are at school. Study purposefully. You will save yourself many future headaches. True, a few find their lifework accidentally, but there are hundreds who never find their right vocations at all. About 20 per cent of workers are occupational misfits. Jobs change rapidly. Employment opportunities are different from when Dad was a boy. They differ from year to year. In the world today, for example, there are more than 300,000 different occupatio ns.To find the right life- work you need to study your interests and abilities and to explore a variety of vocations. Although there are a vast number of occupations from which to choose, certain traits are required for success in any field-accuracy, ambition, loyalty, and perseverance, for example. Is your supply of perseverance low? Do you become discouraged if you don't succeed in something? What are you going to do about it? As a sensible young person who wants to get ahead in the vocation you choose, you are going to start right now to raise your perseverance index.You are going to stick to a difficult task until you've mastered it, because you know that when you get a job or enter a profession, you will be expected to carry to successful completion every task you start. And what about punctuality? You had better form now the habit of being on time, for in business or a profession lateness will count heavily against you. What are your likes and dislikes? Do you prefer to work i ndoors or out? If four walls and a roof stifle your energy and initiative, investigate such vocations as agriculture, forestry, tree surgery, landscape gardening, aviation, fishing, merchant marine, and surveying.Do you like to work with people, things, or ideas? If people interest you, perhaps you'll enjoy the work of a teacher, physician, nurse, personnel interviewer, social worker, minister, salesman, receptionist, lawyer, insurance agent, or librarian. You'd rather work with things? Then such fields as manufacturing, bricklaying, carpentry, tool-making, welding, transportation, mining, dental mechanics, plumbing, repairing, air conditioning, and printing will probably interest you.Or if ideas hold a deep fascination for you, you may be suited for scientific, literary, or economic research, reporting, writing, advertising, accounting, or designing. â€Å"But,† you are probably protesting, â€Å"I like to work with both people and ideas. † That's all right. The physi cian, the teacher, the minister, the lawyer, the librarian, and the reporter, to name but a few, deal with both people and ideas. The architect, the artist, the engineer, and the mechanic, on the other hand, work chiefly with things and ideas . Do you like to debate questions in social studies?Do you enjoy tackling stiff examples in algebra or geometry? Do you stay after school to experiment in the chemistry laboratory? The subjects in which you do best and in which you take keenest interest show where your abilities lie. If you haven't found your strong points, keep on searching. Try other courses-art, music, commercial subjects, or shop work. What do you do in your leisure time? Are you interested in photography? Do you spend happy hours in your laboratory or workshop? Have you a pile of manuscripts hidden away? Do you give puppet shows for the neighborhood children?Do you like to fuss with flowers and plants? Out of your hobby may grow your vocation. As a boy Thomas Edison like n othing better than to tinker with the apparatus in his laboratory. Whatever you choose as your lifework, your chances for success depend in a large measure on your physical and mental well-being. Although your health is largely what you make it, there are individual differences in strength and endurance, which must be considered in the choice of a vocation. The work of an actor, aviator, or reporter is physically more arduous than that of a librarian or writer.A physician, whose rest is interrupted by emergency calls, must have robust health. Select a vocation for which you are physically qualified. When young people enter a job or university/college, school officials are called upon to write letters of recommendation. What is your attendance record? Your school record? Do you participate in sports, other activities? Are you trustworthy? Even when there is a labor shortage, employers want to know these facts about their prospective employees. You are making now the record upon which the school's recommendation will be made.You are interested in a certain broad field of work it may be scientific, mechanical, or commercial. Or it may be artistic work, work with nature, or with people. You n also have a rough idea about your abilities. How are you going to know about the hundreds or even thousands of i different jobs in your chosen field? You probably want to – know the importance of the job, the kind of work, qualifications needed, pay opportunities, advantages, and disadvantages. Will the work you will be doing offer you the opportunity of making the lives of others richer and happier?In recent years careful research has produced a wealth of printed information on almost every type of job. Reading can fill in the gaps in your job observation and experience. In every field there are jobs ranging from those requiring little training to those which require long training and constantly increasing skill. The jobs at the top are fewest. You may be an electrici an's helper or an electrical engineer; a draftsman or an architect; a filing clerk or a private secretary; a dressmaker or a dress designer. Each of these jobs is a useful one, and one may be a step to another.If you have ability, energy, and determination, you will be wise to train yourself for one of the better positions in the field you select. One good way to learn about a vocation is to try it. Have you, like Thomas Edison, sold newspapers? Have you worked in a laboratory, store or garage? Have you done clerical work, coached weak students, or taken care of children? Through such work you may discover hidden talents. Even if you discover no special gift, your wage- earning experience will develop the self-reliance, poise, and sense of responsibility you will need in any vocation. Keep searching and you will find your lifework.

John Locke the State of Nature Essay

In the chapter five of The Second Treatise of Government and A Letter Concerning Toleration, John Locke expresses his opinion about property. According to the Bible, all human being is the descendants of Adam and Eve, which mean that this world is common to all humankind. However, in order to that the property is significant to people, the property must be your own private property. The individuals are different from the land and other properties. Everyone is entitled to the private rights; the personal private property may be obtained by the working, and the personal private property is out of the scope of the public property. Therefore, through manual labour, the public properties become privatization. Nevertheless, the privatization of public property is limited; the way to obtain the private property is only in the situation that does not damage others will be accepted by others. Only under such situation that people have provided appropriate resources to others, can they gain own properties to achieve their satisfactory goals through contribution and work. God gives treasure to humans, but does not look forward to seeing humans using it improperly. God expects humans to share and use the treasure in proper way and by their own work. How much treasure people should earn should be decided according to how much they contribute and need. However, it is not ethical to get properties by violating others. When people cannot implement or distribute natural resources in proper ways, others turn such resources into their own properties via ethically appropriate implementation. The right of gaining property from work is prior than land’s public-owned status, since most of what people gain is via their hard work instead of natural resources. Above all, if people are willing to work on and properly implement public-owned resource properly, such work will give property as a return. In addition, John Locke indicates that the reason why currency came out was people was making efforts on storing some resource which tended easily to go bad, and making them better use and higher profits. Currency does not have actual value, but its value is from the exchange of other resources. It is pointless to occupy extra property which exceeds the actual need and ability of using it, and is not honest either.

2. There Are Numerous Principles Of Medical Ethics That

2 There are numerous principles of medical ethics that are important to consider in ethical arguments and situations. In the theory of principilism, health care professionals base their ethical practice on four principles: autonomy, beneficence, nonmaleficence, and justice. These are all thought to be important principles that should be considered when examining a case involving medical ethics. While it is of the greatest benefit for components of each of these principles to play a part in deciding what is ethically appropriate, I believe that autonomy is the principle that holds the utmost importance. The purpose of this paper is to develop an argument in favour of the statement that autonomy is the most important point to consider when†¦show more content†¦A common denominator in these discussions was the principle of autonomy. Most people agreed that the issue with female genital mutilation is that it is often performed on nonconsenting minors, meaning that if people had been making the choice to have this done to themselves, it would be acceptable as it is only themselves being affected. In the discussion regarding whether a physician should tell a terminal patient their diagnosis if they are thought to be emotionally unstable, the widely accepted answer was still yes, as he should have autonomy over the rest of his medical decisions. In talking about Oregan’s Death with Dignity Act, a lot of people agreed with physician assisted suicide for terminally ill patients meeting certain requirements; these patients make the autonomous decision to end their own lives, rather than endure the agony that living out their disease would likely cause them. While it can be argued that the â€Å"premature† death could cause emotional harm to the family members and therefore does not comply with the principle of autonomy. This is irrelevant, as it is not changing the result of the illness but only speeding up the process. Through the multiple article s and discussionsShow MoreRelatedProfessional Practice Issues Of Health Care Essay1072 Words   |  5 PagesProfessional Practice Issues in Health Care - Ethics Introduction Medical ethics play a huge role in the health care industry. A crucial part of a health care professional s role is to apply appropriate ethical guidelines into clinical settings. Due to its importance there is unlimited amount of references available in different forms regarding to this specific topic, however, the quality, reliability and relevance of each reference can remain questioned and requires further consideration. InRead MoreApplying Ethical Framework in Practice1100 Words   |  5 PagesApplying Ethical Framework in Practice 1. 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