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A2647 - Qualitative Analysis of Nursing Experience with Family Care Rituals (FCR) Intervention: Comparing the American to the Italian Nursing Experience of a Novel Bedside Family-Centered Intervention
Author Block: T. Amass1, G. Villa2, I. Lanini3, T. Walsh4, A. Palmisciano4, R. De Gaudio2, J. Curtis5, M. M. Levy6; 1Pulmonary Critical Care, Brown University/Rhode Island Hospital, Providence, RI, United States, 2Anesthesia/Critical Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy, 3Azienda Ospedaliero Universitaria Careggi, Florence, Italy, 4Pulmonary Critical Care Research Division, Brown University/Rhode Island Hospital, Providence, RI, United States, 5Univ of Washington Harborview Med Ctr, Seattle, WA, United States, 6Pulmonary Critical Care, Rhode Island Hosp, Providence, RI, United States.
Rationale-We recently completed a prospective, multicenter before-and-after trial evaluating engaging family members in hands-on care of patients admitted to the ICU and the impact on persistent stress related symptoms for the families. We developed an intervention of family-centered rituals that allowed families to participate directly in the care of their loved ones. Nurses were surveyed to understand the impact that this had on several aspects of the care they deliver. These surveys identified largely positive responses, and additionally identified some apparent hospital variations in the impact of the intervention between the American and Italian sites. We conducted a qualitative analysis of focus groups of nurses to understand if there were similarities between two different hospitals that would inform possible future interventions to assist family members with providing care for their loved ones. Methods-After site completion of the FCR trial, two of the hospitals participated in nursing focus groups, Rhode Island Hospital (primary American site) and Ospedaliero Careggi (Italian site). Five, hour-long, sessions were held at each site, with a researcher leading and recording sessions with nurses under the condition of confidentiality. Questions during the sessions were created with the guidance of a psychologist with experience in qualitative analysis. The recordings were then transcribed with all identifying information redacted and qualitatively analyzed using content analysis for thematic similarities and differences. Results-Focus groups involved 34 nurses, 10 Italian and 24 American. Similar themes identified include observing families appearing more empowered to participate and ask questions, families requiring time to become comfortable with the act of participating in bedside rituals though becoming very comfortable with and comforted by the act, and nursing feeling more connected to the patient and family through the pictures/personal affects. Differences noted include the increased frequency with which the idea of empowerment was discussed at the Italian site, as well as concerns for having too many people at the bedside potentially interfering with nursing care; however, no interference was noted. These themes were not identified at the American site. Conclusion-Nursing experiences with FCR as an intervention to engage families in the hands-on care of patients in the ICU were largely similar between the Italian and American sites. Importantly, it seemed to improve the nurses’ perception of their relationship with the patient and family, defining an interesting opportunity for further exploration of nursing driven engagement of families at the bedside to reduce stress-related symptoms for families and burnout for nurses.