There is an example and a blank document that needs to be filled out using information from the areticle.
Student Name: XXXXXXXX
EPB Journal Article in APA format:
Sánchez, M., Suárez, M., Asenjo, M., & Bragulat, E. (2018). Improvement of emergency department patient flow using lean thinking. International Journal For Quality In Health Care: Journal Of The International Society For Quality In Health Care, 30(4), 250–256. https://doi.org/10.1093/intqhc/mzy017
Is this an Evidence Based Article? Name of Journal and Year article was written?
Yes
Name of Journal: International Journal for Quality in Health Care
Year: 2018
.2 points
State the problem
What was the goal of the project?
Does this project correlate with your problem? State how?
What are you trying to achieve? Does this article support this goal?
Problem: Delays in the ED compromise quality of care and patient safety while simultaneously increasing mortality and healthcare costs. Internal inefficiencies and poor resource utilization may contribute to delays in care and overcrowding.
Goal: The goal of this project was to achieve a target time of 160 minutes (total), per patient in the ED.
· 80 minutes of “added value” (i.e. specific amount of time with a nurse and doctor for assessment, treatment, and education)
· 60 minutes for lab results
· 20 minutes for treatment steps that could not be eliminated using the Lean process
The goal of our group project is to propose a plan to decrease wait times and improve flow to care areas. The study outlined in this article directly correlates with our group project in that its aim was to tackle the issue of increased wait times leading to delay of care and negative outcomes, including decreased patient satisfaction and the increased risk for mortality. The goal of our group project is to propose a plan to reduce wait times in order to improve patient outcomes, which is exactly what the article’s researchers set out to do by proposing the use of lean principles to eliminate the unnecessary steps/processes that add to wait times.
.2 points
Strengths (Internal)
What’s was good about your article?
Staff Input: This project was heavily supported by the ED staff and administration. In fact, the ED staff were empowered to make the necessary changes by identifying steps (waste) that slowed flow and hindered the care process. They were also tasked with recognizing processes that could be standardized to improve efficiency in care.
Leadership Style: Furthermore, the researchers encouraged a “bottom-up” approach (democratic leadership) to achieve a more enthusiastic acceptance and implementation of the plan. The ED executive team acted as consultants to help support and foster the new process to reduce internal resistance.
Cost: The implementation of the entire project was inexpensive because it did not require third party support or additional supplies.
Did this implantation take place on a unit or area like yours: Yes, this project was implemented in an ED unit.
.4 points
Weakness (Internal)
Staff Support: According to the researchers, the most difficult problem they faced was staff reluctance to abandon their old practices and proceed with implementing the new process of standardization (which required 3 weeks of constant surveillance).
Size: This study was performed in a single ED unit that did not provide services to pediatric or obstetric patients, so it is unknown how well these results might carry over to other specialized ED units. Furthermore, to ensure proper control, the study was limited to a specific unit in the ED, MAT-3, which was the busiest unit in the ED and designated solely for urgent cases.
.4 points
Opportunities (External)
Patient Satisfaction: The results of this study showed that the ED staff was able to reduce wait times, overall care times, and improve patient flow using the lean process to eliminate wasteful steps. However, the researchers could have also measured patient satisfaction to determine if the lean process also improved the correlation between wait times and patient satisfaction.
Staff Satisfaction: The authors recognized that additional research should be completed to analyze how the lean process affects staff members in terms of work satisfaction, turnover, and improved use of skills.
Baseline Data: The researchers found no significant differences in the revisit rate, mortality rate, or leave without being seen rate (LWBS) after implementing the lean process. Suggestions for additional research meant to address these variables were not provided but should be explored, especially due to their relationship with patient safety.
.4 points
Threats – (External)
Validity: The researchers acknowledged that one of the greatest limitations of their study was its external validity since the study was performed in only one ED unit. Their methodology might not produce the same results in a more efficiently run ED unit.
Time: The researchers also agreed that the cultural change needed to fully adapt to this new standardized process would be an ongoing endeavor that would require additional time after the conclusion of the study. The researchers discounted the first 6 months of data because they anticipated that the staff would be more willing to embrace the new process, resulting in a false-positive outcome. Their aim was to observe how time also impacted the lean process in the ED unit in the following months.
Staff Buy In: Finally, the researchers also felt that the cultural/local interpretation of lean principles might differ depending upon location and/or unit. Previous studies concluded that the lean process did not provide clinically relevant results in ED units due to lack of staff buy in resulting from misinterpretation of lean principles. In other words, the staff must understand that the lean process is not a solution but a methodology.
.4 points
Total Points = 2 points
Student Name:
XXXXXXXX
EPB Journal Article in APA format:
Sánchez, M., Suárez, M., Asenjo, M., & Bragulat, E. (2018). Improvement of emergency department
patient flow using lean thinking.
International Journal For
Quality In Health Care: Journal
Of The International Society For Quality In Health Care
,
30
(4), 250
–
256.
https://doi.org/10.1093/intqhc/mzy017
Is this an Evidence
Based Article?
Name of
Journal and Year article
was written?
Yes
Name of Journal
:
International Journal for Quality in Health Care
Year:
2018
.
2
points
State the problem
What was the goal of the
project?
Does this project
correlate with your
problem? State how?
What are you trying to
achieve? Does this
article support this goal?
Problem:
Delays in the ED compromise quality of care and patient
safety
while simultaneously increasing
mortality and healthcare costs.
Internal inefficiencies and poor resource utilization may contribute to
delays in care
and
overcrowding.
Goal:
The goal of this project was to achieve a target time of 160
minutes
(total)
, per patient in the ED.
·
80 minutes
of “added value” (i.e. specific amount of time
with a nurse and doctor
for assessment, treatment, and
education
)
·
60 minutes for lab results
·
20 minutes for treatment steps that could not be eliminated
using the Lean process
The goal of our group project is to propose a plan to decrease wait
times
and
improve flow to care areas. The
study
outlined
in this
article directly correlates with our group project in that
its aim was
to
tackle the issue of increased wait times leading
to delay of care and
negative outcomes, including decreased patient satisfaction and
the
increased
risk
for mortality. The goal of our group project is to
propose a plan to
reduce
wait times
in order
to improve patient
outcomes, which is exactly what the a
rticle’s research
ers
set out to do
by proposing the use of
l
ean
p
rinciples to eliminate
the
unnecessary
steps/processes that add to wait times.
.
2
points
Strengths (Internal)
What’s was good about
your article?
Staff Input
:
This project was heavily supported by the ED staff
and administration. In fact, the ED staff were empowered to make
the necessary changes by identifying steps
(waste)
that slowed flow
and hindered the care process
. They were also tasked with
recognizing
p
rocesses that could be standardized to improve
efficiency in care.
Leadership Style:
Furthermore, the researchers encouraged a
“bottom
–
up” approach (democratic leadership) to achieve a more
enthusiastic acceptance
and implementation of the plan.
The ED
ex
ecutive team acted as
consultants
to help support and foster the
new process
to reduce internal resistance.
.
4
points
Student Name: XXXXXXXX
EPB Journal Article in APA format:
Sánchez, M., Suárez, M., Asenjo, M., & Bragulat, E. (2018). Improvement of emergency department
patient flow using lean thinking. International Journal For Quality In Health Care: Journal
Of The International Society For Quality In Health Care, 30(4), 250–256.
https://doi.org/10.1093/intqhc/mzy017
Is this an Evidence
Based Article? Name of
Journal and Year article
was written?
Yes
Name of Journal: International Journal for Quality in Health Care
Year: 2018
.2 points
State the problem
What was the goal of the
project?
Does this project
correlate with your
problem? State how?
What are you trying to
achieve? Does this
article support this goal?
Problem: Delays in the ED compromise quality of care and patient
safety while simultaneously increasing mortality and healthcare costs.
Internal inefficiencies and poor resource utilization may contribute to
delays in care and overcrowding.
Goal: The goal of this project was to achieve a target time of 160
minutes (total), per patient in the ED.
80 minutes of “added value” (i.e. specific amount of time
with a nurse and doctor for assessment, treatment, and
education)
60 minutes for lab results
20 minutes for treatment steps that could not be eliminated
using the Lean process
The goal of our group project is to propose a plan to decrease wait
times and improve flow to care areas. The study outlined in this
article directly correlates with our group project in that its aim was to
tackle the issue of increased wait times leading to delay of care and
negative outcomes, including decreased patient satisfaction and the
increased risk for mortality. The goal of our group project is to
propose a plan to reduce wait times in order to improve patient
outcomes, which is exactly what the article’s researchers set out to do
by proposing the use of lean principles to eliminate the unnecessary
steps/processes that add to wait times.
.2 points
Strengths (Internal)
What’s was good about
your article?
Staff Input: This project was heavily supported by the ED staff
and administration. In fact, the ED staff were empowered to make
the necessary changes by identifying steps (waste) that slowed flow
and hindered the care process. They were also tasked with
recognizing processes that could be standardized to improve
efficiency in care.
Leadership Style: Furthermore, the researchers encouraged a
“bottom-up” approach (democratic leadership) to achieve a more
enthusiastic acceptance and implementation of the plan. The ED
executive team acted as consultants to help support and foster the
new process to reduce internal resistance.
.4 points
Student Name:
EBP Journal Article in APA format:
Is this an Evidence Based Article? Name of Journal and Year article was written?
Yes/No
Name of Journal
Year:
.2 points
State the problem
What was the goal of the project in the article?
Does this project correlate with your problem? State how?
What are you trying to achieve? Does this article support this goal?
Problem:
Goal:
State how this article correlates with your group problem and goal.
.2 points
Strengths (Internal)
What’s was good about your article?
Why was this project successful?
List attributes of the article, i.e. support from administration, councils, colleagues, institutions.
Did this implementation take place on a unit or area like yours?
.4 points
Weakness (Internal)- issues
Example: lack of education, lack of staffing, staff readiness, lack of support; size, managerial style.
.4 points
Opportunities (External)
Example: Lack of supplies, educational needs, stakeholders, baseline (your baseline data), what needs to be improved?
.4 points
Threats – (External)
Staff buy in, support, limitations and barriers, supply cost, cost of implementation, time, money, realistic?
.4 points
Total Points = 2 points
Student Name:
EBP
J
ournal Article in APA format:
Is this an Evidence Based
Article?
Name of Journal and
Year article was written?
Yes/No
Name of Journal
Year:
.2
points
State the problem
What was the goal of the project
in the article
?
Does this project correlate with
your problem? State how?
What are you trying to achieve?
Does this article support this
goal?
Problem:
Goal:
State how this article correlates
with your group problem and
goal.
.2
points
Strengths (Internal)
What’s was good about your
article?
Why was this project
successful?
List attributes of the article,
i.e. support from
administration, councils,
colleagues, institutions
.
Did this impleme
ntation take
place on a unit or area like
yours?
.4
points
Weakness (Internal)
–
issues
Example: lack
of education,
lack of staffing, staff readiness,
lack of support
; size,
managerial style.
.4
points
Opportunities (External)
Example: Lack of supplies,
educational
needs,
stakeholders, baseline (your
baseline data), what needs to
be improved?
.4
points
Threats
–
(External)
Staff buy in, support,
limitations and barriers, supply
cost, cost of implementation,
time, money, realistic?
.4
points
Total Points = 2 points
Student Name:
EBP Journal Article in APA format:
Is this an Evidence Based
Article? Name of Journal and
Year article was written?
Yes/No
Name of Journal
Year:
.2 points
State the problem
What was the goal of the project
in the article?
Does this project correlate with
your problem? State how?
What are you trying to achieve?
Does this article support this
goal?
Problem:
Goal:
State how this article correlates
with your group problem and
goal.
.2 points
Strengths (Internal)
What’s was good about your
article?
Why was this project
successful?
List attributes of the article,
i.e. support from
administration, councils,
colleagues, institutions.
Did this implementation take
place on a unit or area like
yours?
.4 points
Weakness (Internal)- issues
Example: lack of education,
lack of staffing, staff readiness,
lack of support; size,
managerial style.
.4 points
Opportunities (External)
Example: Lack of supplies,
educational needs,
stakeholders, baseline (your
baseline data), what needs to
be improved?
.4 points
Threats – (External)
Staff buy in, support,
limitations and barriers, supply
cost, cost of implementation,
time, money, realistic?
.4 points
Total Points = 2 points
Feature
©2020 American Association of Critical-Care Nurses doi:https://doi.org/10.4037/ccn2020644
Background Organizations motivated to provide high-quality care in the intensive care unit are exploring
strategies to engage families in patient care. Such initiatives are based on emerging evidence that family
engagement improves quality and safety of care.
Objective To gather family feedback to guide future nurse-led quality improvement efforts to engage
families in the intensive care unit setting.
Methods The Critical Care Family Satisfaction Survey, which consists of 20 items rated from 1 (very
dissatisfied) to 5 (very satisfied), was paired with open-ended questions and administered to families
during the intensive care unit stay from March through December 2017. Content analysis was used to
identify themes regarding the family experience.
Results Responses were collected from 178 family members. The mean (SD) score on the survey was
4.65 (0.33). Five themes emerged regarding the delivery of family care in the intensive care unit: family
interactions with the interdisciplinary team, information sharing and effective communication, family
navigation of the intensive care unit environment, family engagement in the intensive care unit, and
quality of patient care.
Conclusions This quality improvement project provided foundational information to guide family engage-
ment efforts in the intensive care unit. Real-time solicitation of feedback is essential to improving the family
experience and guiding family-centered care delivery in this practice environment. (Critical Care Nurse.
2020;40[6]:42-51)
Natalie S. McAndrew, PhD, RN, ACNS-BC, CCRN-K
Laura Mark, PA-C
Mary Butler, PhD, MSN, RN, FNP-C
Timely Family Feedback to
Guide Family Engagement
in the Intensive Care Unit
Actively engaging families in the intensive care unit (ICU) may improve the quality and safety of care.1-3 An interdisciplinary ICU committee at an academic, tertiary care medical center recog-nized the need to capture timely family feedback to guide nurse-led initiatives aimed at enhanc-
ing family engagement and the delivery of family-centered care.
The organization’s current process for gathering data about the ICU experience is focused solely on
the patient perspective, collects data after discharge from the hospital, and includes few questions about
the patient’s ICU stay. This approach to data collection is limited for a number of reasons. First, ICU
patients typically transfer from the ICU to an inpatient floor before discharge, and their subsequent inpa-
tient experience may eclipse their memory of their ICU stay. Additionally, the duration from ICU stay
until receipt of the survey at discharge could be several weeks, affecting patient recall. Finally, patients
may have limited memories of their ICU stay owing to their illness severity and/or sedation requirements,
42 CriticalCareNurse Vol 40, No. 6, DECEMBER 2020 www.ccnonline.org
www.ccnonline.org CriticalCareNurse Vol 40, No. 6, DECEMBER 2020 43
making family members key informants of patient care
experiences. Therefore, the current patient-focused sur-
vey at the organization may not capture the full range of
the ICU family experience that is needed to guide family
engagement improvement initiatives. To seize potential
opportunities to improve family care in this health care
organization, we developed a quality improvement proj-
ect to better understand the family experience in ICUs
from the family’s perspective. This project was the fi rst
step in an ongoing family engagement improvement
program in the organization’s ICUs.
There is a growing body of research on the family
experience in the ICU and how it affects both patient
and family outcomes.4-6 Family presence in the ICU has
been associated with decreased patient delirium and
anxiety,7 and family-centered interventions may shorten
the patient stay, reduce hospital costs, and improve patient
and family satisfaction and mental health.4,8 As a result,
the quality of care delivered to families has become increas-
ingly valued by health systems.9-11
Family engagement, defi ned as the opportunity for
families to partner with the health care team in ICU
patient care and decision-making, is an important vehi-
cle to achieving patient- and family-centered care in the
ICU.1,12,13 Despite interprofessional recognition that fam-
ily care in the ICU is important, evidence has emerged
that basic family needs are not consistently met.10,14-16
Patient- and family-centered care practice guidelines
recommend fl exible family visitation and family pres-
ence at the bedside; however, family access to patients
is not always a priority for ICU clinicians because of
competing patient care responsibilities.17-19 Organizational
and unit culture may not fully support family engage-
ment in care.18,20-22 Therefore, determining the current
state of family care in the organization’s ICUs is an
important fi rst step to improving family engagement.
Study Framework and Specifi c Aim
The framework for this study was based on the inte-
gration of a concept from the organization’s relationship-
based care model (building therapeutic relationships
with patients and families as the primary goal)23 and a
current defi nition of family engagement: involvement
of families in the ICU through ongoing collaboration to
improve patient care and promote respect (Figure 1).1,13
In this framework, partnership building between health
care professionals and families leads to ongoing collabo-
ration in patient care and decision-making, with the
desired outcomes of mutual respect and therapeutic rela-
tionships (optimal patient and family experiences).
The quality improvement framework was the plan-do-
study-act model conceptualized by William Edwards
Deming.24,25 Improvement efforts were based on a goal
of transforming a primarily patient-focused practice area
into one of family engagement.
The specifi c aim of this project was to better under-
stand the family experience across ICUs to inform the future
development of an ICU family engagement program.
Methods
Context
An interprofessional critical care committee made
up of ICU leaders and clinicians supported this quality
Authors
Natalie S. McAndrew is an assistant professor, College of Nursing,
University of Wisconsin-Milwaukee, and a nurse-scientist, Froedtert
Hospital, Froedtert & Medical College of Wisconsin, Milwaukee,
Wisconsin.
Laura Mark is a physician assistant in the cardiovascular intensive
care unit, Froedtert Hospital, Froedtert & Medical College of
Wisconsin.
Mary Butler is an assistant clinical professor, College of Nursing,
University of Wisconsin-Milwaukee.
Corresponding author: Natalie S. McAndrew, PhD, RN, ACNS-BC, CCRN-K, College of Nurs-
ing, Cunningham Hall, 1921 East Hartford Avenue, Milwaukee, WI 53201 (email:
[email protected]).
To purchase electronic or print reprints, contact the American Association of Critical-
Care Nurses, 27071 Aliso Creek Rd, Aliso Viejo, CA 92656. Phone, (800) 899-
1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email, [email protected]
Figure 1 Guiding framework for the study.
Abbreviation: ICU, intensive care unit.
Partnership Building
Support from ICU health care professionals
Bidirectional information sharing
Ongoing Collaboration
Family involvement in patient care
Shared decision-making in the ICU
Optimal Patient and Family Experiences
Mutual respect
Theraputic relationships
44 CriticalCareNurse Vol 40, No. 6, DECEMBER 2020 www.ccnonline.org
Partnership building between health
care professionals and families leads
to ongoing collaboration in patient
care and decision-making, with the
desired outcomes of mutual respect
and therapeutic relationships.
improvement effort. The project focused on the overall
family experience across 5 ICUs (medical, surgical, trans-
plant, neuroscience, and cardiovascular) at a tertiary
care academic medical center. During the study period
of March through December 2017, the total number of
ICU beds increased from 89 to 107, with at least 500
ICU admissions reported each month.
Intervention
The family experience survey combined an existing
instrument, the Critical Care Family Satisfaction Survey
(CCFSS),26,27 with open-ended questions developed by an
interprofessional team as well as yes/no questions about
basic descriptive hospitalization information. The project
was led by a clinical nurse specialist (N.S.M.) who collab-
orated with the virtual ICU (VICU) nursing director to
implement the
project. Nurses
working in the
telemedicine
service (VICU)
were asked to
play a key role
in the collection
of this critical family feedback. This group was selected
to assist with survey administration to avoid any con-
flict of interest for bedside nurses caring for patients.
The VICU nurses have an ongoing patient monitoring
role in the ICUs and support early recognition of patient
status changes. The VICU nurses share their assessments
with the bedside nurses in the ICU and serve as a tele-
medicine care partner. Additionally, the VICU staff par-
ticipate in many organizational improvement projects
because of their virtual presence in the ICU setting and
interactions with ICU health care professionals. The VICU
nurse checks into each ICU room via camera as part of
their routine patient assessment. When performing this
assessment, VICU nurses may observe family members
visiting the patient.
For the current project, if a VICU nurse noticed a
family member in the room, they called the bedside
nurse to determine if the family member present was
involved in the patient’s care decisions and if it was an
appropriate time to offer family members the oppor-
tunity to participate. If so, the VICU nurse called the
family member on the patient’s phone in the room to
explain the purpose of the survey, assure them that it
was voluntary, and provide directions to interested family
members for survey completion. The VICU nurse called
the health unit coordinator to bring a printed copy of the
survey to the family member. The family member was
informed that, upon completion of the survey, it should
be placed in a sealed envelope and deposited into a locked
box at a central location in each ICU to ensure anonymity.
The VICU tracked whether a patient’s family had been
approached or declined to participate to avoid confusion
or burdening the family with multiple requests.
To optimize return rate, the VICU identified all new
admissions within 24 hours (because the stay might be
short) and continuously monitored for family presence
to identify opportunities to invite families to participate.
Staff nurses fielded the calls from the VICU nurses to
assess appropriate timing for inquiry about completing
the survey. The health unit coordinators in each ICU
answered questions about where to return surveys and
monitored the locked box in which surveys were to be
deposited. Data were entered by a staff nurse and the
clinical nurse specialist into Qualtrics, a secure data
management platform.
Study of the Intervention
Measures. The CCFSS includes 20 items that are
rated from 1 (very dissatisfied) to 5 (very satisfied).26,27
These 20 items are grouped into 5 subscales related to
family care in the ICU: assurance about care of the criti-
cally ill patient, proximity to the critically ill patient,
information about the critically ill patient, family com-
fort, and family support. These important family needs
were first identified in the seminal work of Molter28 and
Leske.11,29 The CCFSS was selected because these subscales
target the specific areas the interprofessional ICU com-
mittee wanted to improve. Items on the tool include
statements about waiting time and requests for assistance,
obtaining information, ability to be with the critically
ill patient, family encouragement and resources, and the
comfort of the ICU waiting room.27 Reliability and valid-
ity of the CCFSS have been shown to be acceptable.26 In
previous studies, internal consistency as measured by the
Cronbach ranged from 0.71 to 0.96.26,30,31 The Cron-
bach for the CCFSS (overall total scale) in the current
quality improvement project was 0.88.
Open-ended questions were developed in an attempt
to better capture the complex experiences of the family.
Open-ended questions were as follows: (1) What do you
www.ccnonline.org CriticalCareNurse Vol 40, No. 6, DECEMBER 2020 45
want us to know about your family member’s stay in the
ICU? (2) How do you think we could improve care for
families in the ICU? (3) What did the ICU team do well
while your family member was in the ICU environment?
(4) Is there anything else you want to share with us? Yes/
no questions captured whether a family conference had
taken place, previous ICU experience, and length of time
in the ICU.
Analysis. Data were exported from Qualtrics into
IBM SPSS Statistics, version 24. Descriptive statistics were
used to examine CCFSS scores (subscales and overall).
Differences in CCFSS scores by ICU type were determined
with analysis of variance. Independent t tests were used
to compare scores on subscales on the basis of whether a
family conference had taken place, as well as whether the
patient had been in the ICU before.
Content analysis, based on the methods described
by Erlingsson and Brysiewicz,23 was used to analyze
responses to open-ended questions. In this approach
to qualitative analysis, data are first condensed into
meaning units, and then codes are formulated to label
these meaning units. Related codes are grouped into
categories, which are then merged into themes that
refl ect the overall meaning of the data.23 Each of us inde-
pendently analyzed the data, and then we used an itera-
tive process to develop consensus on the themes. One of
us (L.M.) completed an additional analysis on the
basis of techniques described by Krippendorff32 to
determine the percentage of feedback that supported
high performance in family care and the percentage
that highlighted opportunities for improvement.
Ethical Considerations
This study was designated by the organization’s
institutional review board as a quality improvement
project and therefore was exempt from further
review (PRO00028444).
Results
Participants
Of the approximately 400 family members who were
approached to participate, 178 completed the survey, for
a response rate of almost 45%. Patients had been in the
ICU an average of 5.85 (SD, 7.72; range, 1-82) days at the
time the survey was completed. Characteristics of family
respondents are shown in Table 1.
CCFSS Responses
The mean CCFSS scores (subscales and overall) are
shown in Table 2. CCFSS scores had a negative skew
(–1.41); these scores did not differ signifi cantly on the
basis of ICU type (Table 3). Those who had a family
conference had signifi cantly higher scores on the prox-
imity subscale than those who did not (P = .03; Table 4).
No signifi cant differences were found in CCFSS scores
according to whether the patient had been in the ICU
before (Table 5).
Qualitative Responses
In response to the 4 open-ended questions, family
members wrote 592 comments. Because responses to
each question were related, comments were analyzed as
a whole rather than by individual question. Family com-
ments were primarily complimentary. Among the com-
ments, 62% described a positive experience. The remainder
of comments were either negative (22%), neutral (12%),
Characteristic
Intensive care unit (ICU)
Cardiovascular ICU
Medical ICU
Surgical ICU
Transplant ICU
Neuroscience ICU
Missing
Did a family conference take place?
Yes
No
Missing
Has your family member previously been in the ICU?
Yes
No
Missing
No. (%)
56 (31.5)
47 (26.4)
34 (19.1)
9 (5.1)
23 (12.9)
9 (5.1)
55 (30.9)
120 (67.4)
3 (1.7)
80 (44.9)
95 (53.4)
3 (1.7)
Table 1 Characteristics of family respondents
(n = 178)
CCFSS
Assurance, mean (SD), range
Proximity, mean (SD), range
Information, mean (SD), range
Comfort, mean (SD), range
Support, mean (SD), range
Overall, mean (SD), range
Score
4.61 (0.41), 1-5
4.61 (0.43), 1-5
4.75 (0.36), 1-5
4.22 (0.88), 1-5
4.76 (0.34), 1-5
4.65 (0.33), 1-5
Table 2 Subscale and overall scores for the
Critical Care Family Satisfaction Survey (CCFSS)
46 CriticalCareNurse Vol 40, No. 6, DECEMBER 2020 www.ccnonline.org
or a combination of both positive and negative (3.4%).
Examples of neutral comments included statements such
as “Not sure” or “Nothing I can think of at this time.”
Figure 2 portrays the 5 interrelated themes that infl uence
the overall ICU family experience: family interactions
with the interdisciplinary team, information sharing and
effective communication, family navigation of the ICU
environment, family engagement in the ICU, and quality
of patient care.
Family Interactions With the Interdisciplinary Team.
The theme of family interactions with the interdisciplinary
team describes how families value their relationships
with ICU staff and recognize that productive interactions
with the team contribute to the delivery of high-quality
patient care. Reflecting on their interactions with mem-
bers of the team, families used the terms friendly, attentive,
professional, caring, skilled, knowledgeable, supportive, warm,
respectful, concerned, helpful, compassionate, and encourag-
ing. Respondents repeatedly emphasized the infl uence of
CCFSS
Overall
Between group
Within group
Total
Assurance
Between group
Within group
Total
Proximity
Between group
Within group
Total
Information
Between group
Within group
Total
Comfort
Between group
Within group
Total
Support
Between group
Within group
Total
P
.43
.94
.81
.06
.51
.41
F
0.97
0.19
0.40
2.30
0.82
1.00
MS
0.10
0.10
0.03
0.16
0.07
0.17
0.26
0.16
0.63
0.77
0.10
0.10
SS
0.39
16.46
16.85
0.12
26.52
26.64
0.28
28.48
28.75
1.06
18.59
19.65
2.55
125.77
128.33
0.42
16.98
17.40
df
4
164
168
4
164
168
4
165
169
4
162
166
4
162
166
4
163
167
Table 3 One-way ANOVA results for the effect
of ICU type on CCFSS scores
Abbreviations: ANOVA, analysis of variance; CCFSS, Critical Care Family
Satisfaction Survey; ICU, intensive care unit; MS, mean square; SS, sum of
squares.
CCFSS
Overall
Assurance
Proximity
Information
Comfort
Support
In ICU
before
4.61 (0.26)
4.55 (0.47)
4.58 (0.45)
4.72 (0.39)
4.11 (0.90)
4.71 (0.38)
Not in ICU
before
4.68 (0.31)
4.64 (0.34)
4.63 (0.42)
4.77 (0.34)
4.32 (0.85)
4.79 (0.31)
P
.15
.12
.47
.38
.12
.18
t
–1.44
–1.59
–0.73
–0.89
–1.57
–1.36
df
170
171
171
169
168
170
Table 5 Comparison of CCFSS scores by
whether the patient had been in the ICU beforea
Abbreviations: CCFSS, Critical Care Family Satisfaction Survey; ICU, intensive
care unit.
a Data are presented as mean (SD).
CCFSS
Overall
Assurance
Proximity
Information
Comfort
Support
Family
conference
4.69 (0.30)
4.59 (0.46)
4.71 (0.37)
4.79 (0.34)
4.25 (0.74)
4.79 (0.30)
No family
conference
4.62 (0.35)
4.61 (0.38)
4.55 (0.45)
4.73 (0.37)
4.21 (0.94)
4.74 (0.37)
P
.23
.74
.03b
.27
.75
.36
t
1.22
–0.33
2.22
1.10
0.32
0.91
df
170
171
171
169
168
169
Table 4 Comparison of CCFSS scores by
whether a family conference was helda
Abbreviation: CCFSS, Critical Care Family Satisfaction Survey.
a Data are presented as mean (SD).
b P < .05.
Figure 2 Model of themes that relate to the
family’s experience in the intensive care unit (ICU).
ICU family experience
Quality of patient care
Family engagement in the ICU
Family interactions
with interdisciplinary
team
Family navigation
of the ICU
environment
Information
sharing and
effective
communication
www.ccnonline.org CriticalCareNurse Vol 40, No. 6, DECEMBER 2020 47
The 5 themes that influence the overall
ICU family experience: family interac-
tions with the team, information sharing
and effective communication, family
navigation of the ICU environment,
family engagement in the ICU, and
quality of patient care.
nurses on their overall ICU experience. As one family
member wrote, “Care and compassion from the nurs-
ing staff was key in making [me] feel comfortable and
confident leaving [my] husband.” Another respondent
echoed the prominent role of nurses, explaining:
The nurses watched and monitored my husband’s
condition very attentively and carefully. Each mem-
ber of the nursing staff was friendly, assuring,
explained medicines and procedures to him and
[our] family and went to great lengths to make
sure that all of my husband’s needs and the needs
and concerns of the family were being met.
Respondents expressed their appreciation for per-
sonalized interactions with physicians: “I loved the
doctor . . . (he) gave me his first name—not his last,
I’ve never had that before. It made it so personal and
provided so much confidence and trust.” Some com-
ments described positive interactions with ancillary
staff members, including environmental services staff,
patient care technicians, respiratory therapists, admin-
istrative assistants, and social workers.
Information Sharing and Effective Communication.
The theme of information sharing and effective communi-
cation describes how families value the opportunity to
receive honest information from the ICU staff conveyed
in a compassionate manner, as well as the opportunity
to share information with the team about the patient
from the family perspective to enhance the quality of
patient care. Respondents expressed a desire for frequent
updates, and many were satisfied that this occurred: “The
team discussed and continually updated treatment plan.
Always fine tuning.” Other family members reported diffi-
culty with “get[ting] information from the MD if you
aren’t here when they are” and asked for more in-person
contact with physicians. Others suggested alternative
methods of communication, such as “a central place to
communicate online with staff and other family members
to keep up to date.” Respondents explained that it was
vital that families stay connected during an ICU stay to
share information and communicate with other family
members who are unable to be present.
Respondents valued clear, honest, consistent, and
open communication with the team. One family mem-
ber reported that “. . . [staff ] were always honest and
open with me, they were never harsh or impatient—
always taking the time to answer my questions and
explain everything to me.” When confusion arose,
family members expressed their appreciation for the
clinicians who answered their questions:
The doctors also explained to my husband and
family members tests and findings, the plan of care
going forward, and made sure they answered our
questions and let us know that they were available
to answer any additional questions the family
might have.
Respondents emphasized that effective communi-
cation included not only answering questions but also
ensuring that those answers were understood.
The perceived quality of communication among health
care providers was also related to families’ appraisal of
effective communication. Some family members reported
that the information they received from various provid-
ers was not always in alignment, resulting in confusion
and distrust. One respondent shared: “It is OVER-
WHELMING to hear from so many doctors, nurses, tech-
nicians and put it in order. Too often they don’t agree
on treatment and we are confused as to what to trust.”
Family Navigation of the ICU Environment.
The theme of family navigation of the ICU environment
describes how families perceive the challenges of manag-
ing as a family within the complex environment of the
ICU and how
this affects
their ability
to provide
supportive
care to the
patient. Some
respondents
described
challenges in obtaining access to their critically ill fam-
ily member. Others expressed frustration about being
limited to only 2 family members at the bedside. Family
members who wanted to spend the night in the ICU
were dissatisfied with hospital policy that discouraged
overnight stays. Family members reported logistical
challenges finding accommodations, as well as psycho-
logical strain on themselves and on patients when
48 CriticalCareNurse Vol 40, No. 6, DECEMBER 2020 www.ccnonline.org
separated. The desire for unrestricted stay in the ICU
was noted most frequently among family caregivers.
One respondent shared: “We (my husband and I) are
the guardians for our son. . . . We are his voice and know
him the best. We don’t care at all for this rule.”
Some family respondents requested a more robust
orientation to the ICU space, policies, and practices: “I
feel we had to figure out a lot of things on our own. . . .
I would like to have an initial introduction or orientation
to resources and facilities available for our family.” For
some families, lack of orientation to the ICU contrib-
uted to misunderstanding about ICU expectations. One
family member explained, “the rules are different in the
ICU [than] in other wings.”
Some respondents described difficulty meeting their
own needs due to the ICU physical environment. The
waiting room was described by some as small, cramped,
cold, and noisy. Others, however, did not share this per-
spective and described the ICU environment as “com-
fortable” and “great.” Respondents who were dissatisfied
with the ICU built environment described important
ways to improve family comfort, including comfortable
seating in the
ICU patient
rooms; private
or semiprivate
space outside
the ICU for
waiting, resting, and sleeping; and easily accessible
bathrooms and showers that would not require check-
ing in and out of the ICU. Families also wanted to be
self-sufficient in meeting their own basic needs near
the ICU, including having convenient access to an ice
machine, cold water, coffee, and a microwave, as well
as phone chargers. Some also requested a faster inter-
net connection.
Family Engagement in the ICU. The theme of
family engagement in the ICU describes families’ desire
to be a partner in care. Families want to feel heard, par-
ticipate in patient care, remain present with their criti-
cally ill family member during some procedures, and
have caregiver consistency to facilitate the family
engagement process. Family members possess unique
knowledge of patients that is valuable in guiding care.
One family member wrote, “Staff should always listen
to family about the patient’s status changing . . . as we
know the patient’s ‘normal’.” Respondents viewed them-
selves as experts on their critically ill family member,
with clinically important knowledge deserving of atten-
tion. Much of this knowledge was tied to family mem-
bers’ roles as caregivers at home. When describing a
change in patient status, one family member commented
that (s)he “[has] all the answers—like if it happened
before or what worked.” Similarly, another family mem-
ber wrote: “We know my son, the patient best. . . . Listen
to him and us. We have a lot of knowledge about my son.”
As caregivers, family members may have encountered
similar scenarios to those that occur in the hospital and
want to share that experience to improve patient care.
In addition to contributing to patient care through
knowledge sharing, family members wished to directly
participate in care. For example, one respondent wrote:
“I would love for the family to be able to be in the room
for certain procedures and to be able to do things like
suctioning . . . .” Family members viewed access to patients
as essential for their own peace of mind but also for
patient well-being. One husband wrote that his “wife
had just been told that she has cancer” and that he
“should have been able to spend the nights with her,
to reassure her that she is not alone.”
Family engagement was enhanced by consistency
in providers and nurses. One family member shared,
Having the SAME NURSES caring for him is the
best part of your ICU. I felt the nurses were always
able to answer my questions and calm me when
I was freaking out because they knew all his issues
and he was also comfortable because he was
familiar with those caring for him.
Another explained, “the continuity and consistency
in care has been comforting and a real support to me.”
Quality of Patient Care. The theme of quality of
patient care describes how families perceive the quality
of care their critically ill family member is receiving in
the ICU and is dependent on their interactions with the
interdisciplinary team, information sharing and effec-
tive communication, navigation of the ICU environment,
and family engagement. The quality of patient care was
perceived positively by the majority of family member
respondents. Many respondents used the open-ended
questions as a means to express gratitude for the quality
Respondents viewed themselves
as experts on their critically ill …
EBP Journal Article
Leadership Team
What kind of Article do I pick?
First review the group project problem and title.
Use key words from your problem for your lookup inquiry. i.e. infection control, nurse, retention, etc.
Use EBP articles no more than 5 years old.
Make sure you put your name at the top and include your article citation in 7th ed. APA format of your assignment - see exemplar.
EBP Journal Article in APA Format
Example:
Student Name: XXXXXXXX
EPB Journal Article in APA format:
Sánchez, M., Suárez, M., Asenjo, M., & Bragulat, E. (2018). Improvement of emergency department patient flow using lean thinking. International Journal For Quality In Health Care: Journal Of The International Society For Quality In Health Care, 30(4), 250–256. https://doi.org/10.1093/intqhc/mzy017
(- Authors – Last name, first initial. Followed by Date in ( parenthesis); Followed by a period. Journal article starts with a capital letter and all other words are lowercase except for words following a colon, semicolon or period within the title. Journal title each letter at the beginning od the word is a capital. This is followed by the volume, chapter and pages. https://www.scribbr.com/apa-style/in-text-citation
/ )
2 points - EBP
thE Problem and The Goal
SWOT – “S” is for strengths
Strength - Example: Did they have support of the peers, manager, CEO. Did this project improve patient satisfaction, quality, efficiency? Usually found in the literature review and results
7
SWOT – “W” is for Weakness
Weakness - Example: This is the opposite. Why was this weak? Not enough education, no support, not enough money because of the expense? Usually found in the problem of the literature review, results and limitations.
8
Swot – “O” is for Opportunity
Opportunity - Example: If there wasn't enough education, is this an opportunity? A better survey or tool? Usually found in results or limitation and future implications.
9
Swot – “t” is for Threats
Threat - Example: Increased infection, possible death, etc. Usually found in the literature review.
10