Family outcomes following patient transfer from intensive care : an educational intervention
Mitchell, Marion Lucy (2003) Family outcomes following patient transfer from intensive care : an educational intervention. PhD thesis, Queensland University of Technology.
Introduction: The purpose of this study was to improve family members' transfer from Intensive Care. A structured pre-transfer educational method of patient transfer was introduced and evaluated. Background of the study: Many studies have documented the needs of family members whilst in intensive care units (ICU) but few have evaluated interventions to support meeting these needs. No studies have documented 'uncertainty in illness' levels of family members around transfer from ICU or the relationship between uncertainty and anxiety. Method: The study used a quasi-experimental pre-test, post-test non-equivalent control group design based on the General System Theory (von Bertalanffy, 1972). There were four phases to the study with the intervention grounded in Knowles' Adult Learning Theory (1980). Family members of patients in an ICU were purposively allocated to a control(n = 80) and intervention group (n = 82). A pre-test, post-test strategy was used with data from the control group collected first and once completed, the intervention was introduced into the ICU. The intervention group data were then collected using the same data collection tools. The intervention group experienced a transfer method designed to improve communication with the bedside nurse in ICU whereas the control group received existing ad hoc transfer methods. Participants were surveyed before and after transfer using Spielberger et al.'s state anxiety inventory and Mishel's 'uncertainty in illness' scale. Demographic data were collected for both patients and family members together with family members' satisfaction with the transfer process they experienced. At the completion of the study, intensive care nurses (n = 40) were surveyed to assess their perception of the efficacy of the intervention. Results: Three factors were found to significantly affect levels of 'uncertainty in illness' and these included state anxiety scores (F = 50.9, p < .000), the relationship of the family member to the patient (F = 2.9, p = .022), and the unexpected nature of the admission (F = 23.09, p < .000). These factors accounted for 33% of the variance of 'uncertainty in illness' scores. State anxiety levels were significantly affected by the degree of family social support (F = 10.0, p = .002) and uncertainty as previously mentioned. State anxiety reduced significantly following transfer for both groups and 'uncertainty in illness' reduced significantly for the intervention group (t = 2.21, p = .03).When controlled for pre-transfer levels, however, there was no significant reduction in the intervention group when compared with the control group.' Uncertainty in illness' for the intervention group reduced, however, whereas scores for the control group did not. The intervention group experienced significantly higher levels of satisfaction with transfer (Z = -2.43, p = .015) and felt significantly better prepared for transfer(Z = -3.26, p = .001) than did the control group. The vast majority of ICU nurses(90.6%) thought the intervention provided a useful framework for discussing the patient's condition with family members and 94% thought it should be introduced for all transfers from ICU. Conclusions: Uncertainty is significantly related to state anxiety in this sample. Previous research suggests that individual's coping ability is affected by both anxiety and' uncertainty in illness' which limit their adaptation to the new ward situation. This results in relationship disturbances and psychological distress (Mishel, 1981)at a time when patients rely on family support. The intervention reduced uncertainty and improved family members' satisfaction with the transfer process by improved communication between family members and ICU nurses. The intervention was fully endorsed and supported by ICU nurses who recommended its introduction for all future transfers.
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|Item Type:||QUT Thesis (PhD)|
|Supervisor:||Courtney, Mary & Coyer, Fiona|
|Keywords:||Family members, Intensive Care, Transfer, Anxiety, Uncertainty in illness, Satisfaction, Pre-transfer education, General System Theory, Adult Learning Theory|
|Department:||Faculty of Health|
|Institution:||Queensland University of Technology|
|Copyright Owner:||Copyright Marion Lucy Mitchell|
|Deposited On:||03 Dec 2008 03:49|
|Last Modified:||28 Oct 2011 19:39|
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