dissecting journal - Achiever Papers

There is an example and a blank document that needs to be filled out using information from the areticle.

>Student

Name

XXXXXXXX

EPB Journa

Article in APA format:

Sánchez

, Suárez, M., Asenjo, M., & Bragulat, E. (

018

)

. Improvement of emergency department

patient flow using l

ean

thinking.

International Journal For

Quality In Health Care: Journal

Of The International Society For Quality In Health Care

(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

points

State

the

problem

What was the goal of the

project?

Does this project

correlate with your

problem? State how?

What are you trying

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

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

actly what the a

rticle’s research

ers

set out to do

by proposing the use of

lean 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

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

ecutive 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.

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

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:

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?

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:

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.

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?

points

Weakness (Internal)
–

issues

Example: lack
of education,
lack of staffing, staff readiness,
lack of support
; size,
managerial style.

points

Opportunities (External)

Example: Lack of supplies,
educational

needs,
stakeholders, baseline (your
baseline data), what needs to
be improved?

points

Threats
–

(External)

Staff buy in, support,
limitations and barriers, supply
cost, cost of implementation,
time, money, realistic?

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

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 Uni

A
ctively 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:
mcandre3@uwm.edu).

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, reprints@aacn.org.

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)

CCF

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