Crystal Dea Moore

The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intensive care unit.

Objective:The study examined the effect of adding a full-time family support coordinator to the surgical intensive care unit team on family satisfaction, length-of-stay, and cost in the surgical intensive care unit. Design, Setting, and Patients:A quasi-experimental design was conducted in two phases: baseline (8 mos) and intervention (10 mos) phases. Data on family satisfaction, length-of-stay, and costs from both phases were collected. Interventions:The intervention added a new role, the family support coordinator, to the surgical intensive care unit team. The family support coordinator functioned as a liaison between the patient’s family and the health care team. Measurements and Main Results:The results revealed that generally the intervention was associated with increases in family satisfaction with communication for all surgical intensive care unit team members, with physicians, social workers, and respiratory care therapists showing increases in significance. The largest increase was for physician communication (p = .0034). Families also rated their perceptions of the quality of care provided to their family members by various members of the surgical intensive care unit team. Mean ratings increased for all areas of care, with respiratory and nursing care showing the largest increases. Families’ perceptions of the care and treatment they received during the stay of their family member showed increases in all areas of satisfaction between baseline and intervention, particularly those areas most related to the intervention. Conclusions:The implementation of the family support coordinator intervention increased family satisfaction across a range of parameters. Although there were decreases in length-of-stay and costs, they were not statistically significant. Further research is needed to determine whether intervention refinement could produce lower length-of-stay and costs.

The Co-Occurrence of Child Abuse and Domestic Violence: An Issue of Service Delivery for Social Service Professionals

In order to add to the growing literature on intergenerational rates of family violence, data were collected from a community-based child abuse agency. The studys purpose was to compare the co-occurrence of child abuse/neglect (CAN) and domestic violence (DV), and the prevalence of CAN and parents childhood history of abuse. Data were collected from 537 families through intake and subsequent interviews in an attempt to determine the relationship among CAN and DV, and CAN and parents childhood history of abuse. A chi-square analysis indicated significant relationships among these variables. Of the participants in this sample, 48.9% had experienced both CAN and DV. These results also indicated that 66.3% of participants had a childhood history of CAN and were currently experiencing issues of CAN with their own children. Logistic regression was utilized to examine whether families involved with Child Protective Services (CPS) were at higher risk for DV and/or parental childhood history of CAN. The results indicate that CPS-involved families were approximately three times as likely to have a parent reporting a childhood history of CAN but were not at significantly higher odds for DV. Implications for service delivery are discussed.

Frail Elders’ Experiences With and Perceptions of Health

In this study we explored frail elders’ experiences with and perceptions of the phenomenon of health so as to develop a deeper understanding of living with diseases and disorders in old age. Frail elders participated in qualitative interviews that explored the meaning of the phenomenon of health for them. Eleven men and 11 women, who had diverse ratings of self-perceived health ranging from poor to excellent, were selected by means of a purposeful strategic sampling of frail elders taken from a broader sample that participated in a larger quantitative study on health. In total, 22 individual interviews were analyzed using Giorgi’s descriptive phenomenology. We found that frail elders described health as being in harmony and balance in everyday life, and this occurred when participants were able to adjust to the demands of their daily lives in the context of their resources and capabilities.

Holding on to the indispensable medication -A grounded theory on medication use from the perspective of persons with medication overuse headache

BackgroundMedication overuse headache (MOH) is a chronic headache disorder, caused by overuse of acute medication. To date, it remains unclear why some people overuse these medications. The aim of this qualitative study was to explore how individuals with MOH use medications and other strategies to manage headaches in their daily lives, and their thoughts about their own use of acute medication. Our intention was to develop a theoretical model about the development of MOH, from the perspective of those with MOH.MethodsData collection and analysis were conducted according to grounded theory methodology. The participants were recruited via newspaper advertisements. Fourteen persons with MOH were interviewed in individual qualitative interviews.ResultsThe basic process leading to medication overuse was holding on to the indispensable medication. The acute medication was indispensable to the participants because they perceived it as the only thing that could prevent headaches from ruining their lives. The participants perceived headaches as something that threatened to ruin their lives. As a result, they went to great lengths trying to find ways to manage it. They tried numerous strategies. However, the only strategy actually perceived as effective was the use of acute medication and they eventually became resigned to the idea that it was the only effective aid. The acute medication thus became indispensable. Their general intention was to use as little medication as possible but they found themselves compelled to medicate frequently to cope with their headaches. They did not like to think about their medication use and sometimes avoided keeping track of the amount used.ConclusionsThis qualitative study adds understanding to the process via which MOH develops from the perspective of those having MOH. Such knowledge may help bridge the gap between the perspectives of patients and health-care professionals.

Evaluation of an Intervention Designed to Help Divorced Parents Forgive Their Ex-Spouse

This study evaluated a 1-day workshop combined with postintervention journal writing designed to help divorced parents forgive their ex-spouse. Participants (N = 99) were randomly assigned to a workshop with gratitude journal condition (WG), the same workshop with daily events journal condition (WDE), or a wait-list comparison condition (WAIT). Participants completed measures of forgiveness, well-being, and parenting at pretest, posttest (i.e., after the workshop but prior to journaling), and 1-month follow-up (i.e., after the journaling). Consistent with hypotheses, forgiveness of an ex-spouse and dispositional forgiveness were positively related to coparenting, and forgiveness of an ex-spouse was related to better mental health. Participants assigned to WG improved more on situational and dispositional forgiveness as compared to other conditions. Contrary to hypotheses, participants in WG and WDE did not improve over time more than WAIT participants on mental health or parenting measures.

From Nursing Home to Green House: Changing Contexts of Elder Care in the United States

This article tracks the changing roles of certified nursing assistants (CNAs) as they transition from a traditional nursing home setting to a “deinstitutionalized” care setting called the Green House. The Green House concept, developed by William Thomas, MD and based on the Eden Alternative paradigm, emphasizes autonomy, dignity, privacy, and reciprocal relationships between residents and staff. This qualitative work focuses on how CNAs (called “shabazim” in the Green House) negotiated the transition from traditional nursing home to the Green House model. Interview, focus group, and participant observation data before and after the transition to the Green Houses reveal that in the traditional nursing home environment, informants report that resident-CNA interactions tend to be rushed, detached, and adversarial, whereas in the Green House care environment, interdependency and stronger ties are promoted. Shabazim report diminished guilt and enhanced sense of empowerment in their new role.

The Effect of a Family Support Intervention on Physician, Nurse, and Family Perceptions of Care in the Surgical, Neurological, and Medical Intensive Care Units

Many patients in the intensive care unit (ICU) have predictable medical and discharge outcomes, but some trajectories are marked with medical uncertainty. Stressed family-surrogates receive multiple medical updates from a variety of personnel. These circumstances can lead to confusion, which may result in conflicts and dissatisfaction with care. This study examined the effects of adding a family support coordinator to the surgical, neurological, and medical ICUs on family, physician, and nurse satisfaction with communication and care. A quasi-experimental design was conducted in 2 sequential phases (baseline and intervention). The data sources were 2 surveys: (1) Family Satisfaction Survey and (2) Nurse and Physician Perception and Satisfaction Survey. Family Satisfaction Survey data, a combined data set, were collected in the 3 ICUs. Nurse and Physician Perception and Satisfaction Survey data were collected from the attending physicians and critical care nurses in the medical and neurological ICUs. Results show that family ratings of satisfaction with ICU team communication and care generally increased as a result of the intervention. Overall, physician and nurse perceptions of communication and care did not change as a result of the intervention.

Surrogate Decision-Making: Judgment Standard Preferences of Older Adults

Abstract This qualitative study examines the judgment standard preferences of older adults related to surrogate decision-making for medical treatment. Thirty community dwelling adults over the age of 60 were presented with scenarios that depicted three decision-making standards, two of which are the predominant legal standards (substituted judgment and best interests), and a proposed third standard that allows the surrogate to consider the interests of the family in the decision-making process (best judgment). Half of the sample preferred substituted judgment, five preferred best interests, and ten chose best judgment. Selected cases are presented that demonstrate the themes associated with each judgment Standard preference.

Enhancing Health Care Communication Skills: Preliminary Evaluation of a Curriculum for Family Caregivers

Abstract The Communicating Effectively with Health Care Professionals (CE) workshop curriculum is designed for family caregivers to encourage caregiver empowerment, effective health care communication, and advocacy in medical care contexts with the goal of promoting positive health outcomes for care recipients. This mixed-method study employed a cross-sectional quantitative mail survey (N= 51) and semi-structured qualitative telephone interviews (N= 14) to examine the effectiveness of the curriculum in promoting self-reported changes in caregiver attitudes and communication behavior. Respondents reported increased as-sertiveness in medical encounters, feelings of empowerment, and preparation and organization of medical information for their care recipients as a result of workshop participation.

Clinical Update: Communication Issues and Advance Care Planning

OBJECTIVES To provide a clinical update on practical strategies to enhance the quality of communication in the palliative and end-of-life medical care settings. DATA SOURCES Published articles, textbooks, reports, and clinical experience. CONCLUSION The components of effective and compassionate care throughout the advanced illness trajectory require thoughtful and strategic communication with patients, families, and members of the health care team. Unfortunately, few health care professionals are formally trained in communication skills. IMPLICATIONS FOR NURSING PRACTICE Nurses who possess self-awareness and are skilled in effective communication practices are integral to the provision of high-quality palliative care for patients and families coping with advanced malignancies.