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Contents

        Preface: Family-Centered Care: A Reflection xiii

        Judy E. Davidson and Carrie Anne Hudson

        Humanizing Intensive Care: From Theory to Practice 135

        José Manuel Velasco Bueno and Gabriel Heras La Calle
        The International Research Project for the Humanization of Intensive Care Units (Proyecto HU-CI) was initiated in 2014. The aim of this project is to change the current paradigm toward a human-centered care model. Patients, families, and professionals (everyday stakeholders) were asked to describe their ideal intensive care unit (ICU). Using their opinions, 8 fields of research to improve the management of ICUs and change the reality of care throughout the world were designed. This replicable tested model to humanize the ICU care delivery model is presented.

        Family Integrated Care for Preterm Infants 149

        Linda S. Franck, Chandra Waddington, and Karel O’Brien
        Parent-infant separation is a major source of stress for parents of hospitalized preterm infants and has negative consequences for infant health and development. Family Integrated Care (FICare) uses a strengths-based approach, based on family-centered care principles to promote parental empowerment, learning, shared decision making, and positive parent-infant caregiving experiences. Outcomes of FICare include increased self-efficacy upon discharge and improved parent-infant relationships and infant developmental outcomes. In this article, the authors describe the FICare model and emerging evidence regarding outcomes of FICare for infants and families and discuss challenges and opportunities in implementing and maintaining high-quality FICare.

        The Best Medicine: Personal Pets and Therapy Animals in the Hospital Setting 167

        Denise Barchas, Melissa Melaragni, Heather Abrahim, and Eric Barchas
        Companion animals can have a positive impact on people’s health and well-being. Personal pet visitation and animal-assisted interventions (AAIs) can benefit patients’ pain, blood pressure, stress, depression, and anxiety, as well as increasing mobility and socialization with staff and families. Implementing personal pet visitation and/or AAI programs requires the involvement of stakeholders from multiple disciplines. AAI is generally well received by staff. Animal presence in the intensive care unit carries few risks for humans and animals but is not risk free. Programs should be designed to minimize these risks. Effective planning can create programs that support patient-centered and family-centered care.

        Sleep in the Intensive Care Unit: Biological, Environmental, and Pharmacologic Implications for Nurses 191

        Karin Reuter-Rice, Mary Grace McMurray, Elise Christoferson, Haley Yeager, and Brooke Wiggins
        There is a clear relationship between lack of sleep, poor health outcomes, and delayed recovery from illness in the intensive care unit. Several factors can contribute to poor quality sleep in the intensive care unit, including (1) environmental disruptions such as light and sound, (2) physiologic disruptions such as discomfort, nausea, and pain, (3) psychological disruptions such as anxiety and a lack of privacy, and (4) health care provider-related disruptions, such as medication administration and nursing care. Nursing implications include increased attention to the role of sleep to promote intensive care unit patient’s health outcomes and using multicomponent sleep-promoting protocols.

        Implementation of a Patient and Family-Centered Intensive Care Unit Peer Support Program at a Veterans Affairs Hospital 203

        Leanne M. Boehm, Kelly Drumright, Ralph Gervasio, Christopher Hill, and Nancy Reed
        Peer support is a novel strategy to mitigate postintensive care syndrome and postintensive care syndrome–family. This project implemented a peer support program to address postintensive care syndrome for patients and family members. Using a free-flow, unstructured format, a chaplain, social worker, nurse, and intensive care unit survivor led veterans and loved ones in discussion of intensive care unit experiences, fears, and the challenges of recovery. Evaluations indicated group participation is beneficial for emotional support, coping, and understanding common situations related to prolonged intensive care unit stay. A majority reported they would strongly recommend group participation to a friend.

        Engaging Patients and Families to Help Research Inform and Advance Patient and Family–Centered Care in Critical Care Medicine 211

        Peter Oxland, Nadine Foster, Kirsten M. Fiest, and Yoanna Skrobik
        Intensive care unit (ICU) patient, and family member engagement is evolving in both critical care medicine practice and research. The results of two qualitative critical care research projects led by ICU survivors and family members show how patient-partner research training can inform the critical care community of meaningful priorities in the traumatic ICU context. The resulting creation of a prioritized list of critical care research topics builds further on the construct of patient-centered care.

        Impact of Patient and Family Involvement in Long-Term Outcomes 227

        Christopher J. Grant, Lauren F. Doig, Joanna Everson, Nadine Foster, and Christopher James Doig
        Surviving a critical illness can have long-term effects on both patients and families. These effects can be physical, emotional, cognitive, and social, and they affect both the patient and the family. Family members play a key role in helping their loved one recover, and this recovery process can take considerable time. Transferring out of an intensive care unit, and discharging home from a hospital, are important milestones, but they represent only the beginning of recovery and healing after a critical illness. Recognizing that these challenges exist both for patients and families is important to improve critical illness outcomes.

        Implementation of a Standardized Patient/Family Communication Bundle 243

        Carrie Sona, Kathryn A. Pollard, Marilyn Schallom, Anne Schrupp, and Brian T. Wessman
        During critical illness, active discussions about a person's preferences are linked with better patient outcomes. Our intensive care unit implemented an evidence-based standardized communication bundle that included education to providers on effective family communication, focused patient/family discussions to identify Durable Power of Attorney/surrogate decision maker and obtaining advanced directive documents, and documenting conversations in the electronic medical record and appropriately updating the patient's code status. The aim of the bundle was to increase compliance with conducting and documenting family discussions, clearly identifying and documenting surrogate decisions makers, and to improve patient/family satisfaction and caregiver satisfaction.

        One Team’s Experience with Integrating Flexible Visitation in the Medical Intensive Care Unit 253

        Chris Winkelman, Kathleen Kerber, Jessica Zangmeister, and Molly McNett
        Integration of flexible visitation into a large health system requires concentrated effort. Evaluating impact on patient, family, and staff outcomes is important to facilitate changes and ensure visiting policy success. The medical intensive care unit staff participated in a collaborative quality improvement effort to encourage flexible visitation. The integration of flexible visitation spanned an 18-month period, timed to accompany a transition to a new setting with rooms designed to support visitor presence. This article details these efforts, outcomes, and important gaps for future work evaluating integration of flexible visitation in critical care.

        The Critical Care Nurse Communicator Program: An Integrated Primary Palliative Care Intervention 265

        Andrew O’Donnell, April Buffo, Toby C. Campbell, and William J. Ehlenbach
        Twenty percent of Americans die in an intensive care unit (ICU), often incapacitated or requiring assisted decision making. Surrogates are often required to make urgent, complex, high-stakes decisions. Communication among patients, families, and clinicians is often delayed and inefficient with frequent missed opportunities to support the emotional and psychological needs of surrogates, particularly at the end of life. The Critical Care Nurse Communicator program is a nurse-led, primary palliative care intervention designed to improve the quality and consistency of communication in the ICU and address the informational, psychological, and emotional needs of surrogate decision-makers through the shared decision-making process.

        Bereavement Care in the Adult Intensive Care Unit: Directions for Practice 281

        Alyssa Erikson and Jennifer McAdam
        Bereavement support is recommended as part of family-centered care in critical care settings. This literature review describes the impact on a family after the death of a loved one in the intensive care unit (ICU) and how bereavement services could help. Potential components of a bereavement program are explored, including tangible contents (eg, bereavement brochure, sympathy card, memory making), family preferences, and optimal timing. A bereavement risk assessment tool is also described to more optimally meet families’ needs. Finally, the goal of this review is to guide ICUs in planning and developing of a successful and sustainable bereavement program.

        Enhancing Family-Centered Care in Cardiothoracic Surgery 295

        Kelly A. Thompson-Brazill, Catherine C. Tierney, Lori Brien, Jeremy W. Wininger, and Judson B. Williams
        The psychological impact of critical illness is far reaching, affecting patients and their loved ones. Family members face a multitude of stressors, ranging from concerns about death or permanent disability to anxiety over health care costs and lost wages. Patients are at risk for developing post–intensive care syndrome. Professional groups and patient safety organizations have crafted family-centered care (FCC) models that support hospitalized patients and their families. There is a paucity of data on use of FCC in cardiothoracic intensive care units. This article discusses FCC models and why they are beneficial to the needs of families of postoperative cardiothoracic surgery patients.

        Intensive Care Unit Patient Diaries: A Review Evaluating Implementation and Feasibility 313

        Erica McCartney
        Post–intensive care syndrome is a detrimental cluster of symptoms that can have a negative impact on life after discharge from the intensive care unit (ICU). The use of patient diaries while hospitalized in the ICU has been reported to help survivors and families create memories and fill in gaps from their hospitalization. A review of the literature revealed that patient selection, diary content, family involvement, and staff perceptions are essential to the implementation of a diary program. Understanding the importance and impact diaries can have on survivors increases compliance and sustainability of this program.

        Nurses’ Influence on Patient Wellbeing: Noise Reduction and Sunshine Therapy 327

        Fiona A. Winterbottom, Karla LeBlanc-Lucas, and Alexandra Boylan
        This article describes 2 nurse-driven programs that aimed to improve patient wellbeing and decrease ICU stressors to improve the ICU experience. One program addressed noise reduction and the other describes Sunshine Therapy.

        The Facilitated Sensemaking Model as a Framework for Family-Patient Communication During Mechanical Ventilation in the Intensive Care Unit 335

        Ji Won Shin, Judith A. Tate, and Mary Beth Happ
        Family caregivers of intensive care unit (ICU) patients are at high risk for adverse psychological outcomes. Communication difficulty due to mechanical ventilation may induce or worsen adverse psychological outcomes. The Facilitated Sensemaking Model (FSM) is the first model to guide nursing interventions to help ICU family caregivers overcome and prevent adverse psychological outcomes. We address an understudied phenomenon, communication between patients and family caregivers during mechanical ventilation. The FSM guides supportive interventions for critical care nurses to improve patient-family communication in the ICU. We provide an example of communication intervention, an electronic communication app, within the preexisting FSM.