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Research Oral Abstract Award Winner Purpose: This descriptive pilot study explored use of electronic augmentative and alternative communication (AAC) devices with nonspeaking adults in medical ICU. Background/Significance: Critically ill patients [...]

Intensive care unit (ICU) nurses occupy an essential role in facilitating patient communication and preventing the detrimental effects experienced by critically ill patients who are unable to speak, yet most are not equipped with the tools or training to enable communication most effectively with patients who are unable to speak. The goal of the Study of Patient-Nurse Effectiveness with Assisted Communication Strategies (SPEACS-2) is to explore the impact of an innovative, Web-based instructional package for ICU nurses with pocket reference guides, an instructional manual, and the provision of 'low-tech' augmentative and alternative communication materials on nursing care quality and patient clinical outcomes. We hypothesize that this intervention will 1) improve nurses' skills in assessing and communicating with ICU patients who are unable to speak and 2) increase the collaboration between nursing and speech-language pathology in addressing complex patient communication needs in the ICU. [ABSTRACT FROM AUTHOR]

Behavioral observation is a fundamental component of nursing practice and a primary source of clinical research data. The use of video technology in behavioral research offers important advantages to nurse scientists in assessing complex behaviors and relationships between behaviors. The appeal of using this method should be balanced, however, by an informed approach to reliability issues. In this article, we focus on factors that influence reliability, such as the use of sensitizing sessions to minimize participant reactivity and the importance of training protocols for video coders. In addition, we discuss data quality, the selection and use of observational tools, calculating reliability coefficients, and coding considerations for special populations based on our collective experiences across three different populations and settings. [ABSTRACT FROM AUTHOR]

This article distinguishes between parallel and integrated mixed methods research approaches. Barriers to integrated mixed methods approaches in gerontological research are discussed and critiqued. The author presents examples of mixed methods gerontological research to highlight approaches to data integration at the levels of data analysis, interpretation, and research reporting. As a summary of the methodological literature, four basic levels of mixed methods data combination are proposed. Opportunities for mixing qualitative and quantitative data are explored using contemporary examples from published studies. Data transformation and visual display, judiciously applied, are proposed as pathways to fuller mixed methods data integration and analysis. Finally, practical strategies for mixing qualitative and quantitative data types are explicated, as gerontological research moves beyond parallel mixed methods approaches to achieve data integration. [ABSTRACT FROM AUTHOR]

The research committee of the Hospice and Palliative Nurses Association engaged in an iterative process to develop a research agenda for the association that is expected to provide a focus for graduate students and junior and senior researchers and guide our organization's research funding. In addition, this agenda will illustrate to stakeholders the importance of these research foci. The focus of this article is twofold: to describe the process for developing the agenda and describe the agenda itself with rationale for the foci. [ABSTRACT FROM AUTHOR]

We describe patterns of communication of patients involved in health-related decision making during prolonged mechanical ventilation (PMV). Data were collected using observation, interview, and record review. Twelve of 30 patients participated in decisions about initiating, withdrawing, and withholding life-sustaining treatment, surgery, artificial feeding, financial/legal issues, discharge care, and daily care procedures. Patient involvement was largely validation or confirmation of what clinicians and families had already decided. Patients' participation was enlisted by clinicians and family members even when the patients did not exhibit full decisional capacity. Patient involvement in health-related decisions during prolonged critical illness is a shared and negotiated process that requires continued empirical study and ethical analysis. (c) 2007 Wiley Periodicals, Inc. Res Nurs Health 30:361-372, 2007. [ABSTRACT FROM AUTHOR]

At first glance, the goals of palliative care and lung transplantation seem incongruent, particularly if maintaining readiness for transplantation involves fully aggressive care. But are these goals truly inconsistent? [ABSTRACT FROM AUTHOR]

This paper presents two interrelated psychosocial constructs, voicelessness and interpretation, which were derived from a participant observation study of critically ill older adults in the USA. Voicelessness occurs when physiological, psychosocial and/or technological barriers limit the abilities of critically ill patients to represent their thoughts, feelings, desires and needs fully to others. Voicelessness influences not only the responses of critically ill patients to their condition, environment and caregivers, but also profoundly effects the responses of family members and clinicians. Thus, communicative interactions as well as certain clinical and treatment decisions in ICU hinge on clinician and family member interpretation of patients' nonvocal behaviors. Conditions and factors contributing to interpretation are described and a hypothesis proposed, that interpretation mitigates the detrimental effects of voicelessness. [ABSTRACT FROM AUTHOR]

The death of a beloved grandmother heightened this ICU nurse's sensitivity to issues in her practice. [ABSTRACT FROM AUTHOR]

Objectives: Critically ill adults requiring artificial airways experience profound communication deficits. Studies of interventions supporting communication report disparate outcomes, creating subsequent challenges in the interpretation of their effectiveness. Therefore, we aimed to develop international consensus for a communication core outcome set (Comm-COS) for future trials of communication interventions in this population., Design: 1) Systematic review, 2) patient/family interviews, 3) two-round modified Delphi, and 4) virtual consensus meetings with a final voting round. A multidisciplinary expert steering committee oversaw all stages., Setting: Interviews and consensus meetings were conducted via videoconferencing. Digital methods were used for Delphi and final Comm-COS voting., Subjects: Three stakeholder groups: 1) patient and family members with lived experience within 3 years, 2) clinicians with experience working in critical care, and 3) researchers publishing in the field., Intervention: None., Measurements and Main Results: We identified 59 outcomes via our systematic review, 3 unique outcomes from qualitative interviews, and 2 outcomes from our steering committee. Following item reduction, 32 outcomes were presented in Delphi round 1; 134 participants voted; 15 patient/family (11%), 91 clinicians (68%), and 28 researchers (21%). Nine additional outcomes were generated and added to round 2; 106 (81%) participants voted. Following completion of the consensus processes, the Comm-COS includes seven outcomes: 1) changes in emotions and wellbeing associated with ability to communicate, 2) physical impact of communication aid use, 3) time to functional communication, 4) ability to communicate healthcare needs (comfort/care/safety/decisions), 5) conversation agency, 6) ability to establish a communication connection to develop and maintain relationships, and 7) acceptability of the communication intervention., Conclusions: This is the first COS to specifically focus on communication for critically ill adults. Limitations for operationalization include selection of measures to use with these outcomes. Identification of suitable measures and adoption of the Comm-COS in future trials will help establish effective interventions to ameliorate the highly prevalent and negative experience of communicative incapacity., Competing Interests: Dr. Freeman-Sanderson received support for article research from an internal university seed grant from Faculty of Health, University of Technology Sydney (UTS). Dr. Brodsky’s institution received funding from the National Institutes of Health and the Food and Drug Administration; he received funding from MedBridge and Phagenesis. Dr. Happ received funding from internal research funds, the Healthy State Alliance Momentum grant; she disclosed that she holds the copyright to the Study of Patient-Nurse Effectiveness with Assisted Communication Strategies (SPEACS-2) online communication training program. Sullivan’s institution received funding from UTS. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)

Context: Reliable and valid measures are critical in accurately assessing outcomes of advance care planning interventions (ACP) for end-of-life (EOL) decision-making., Objectives: To develop measures of preparedness for EOL decision-making for patients with end-stage renal disease and their surrogates (an exemplar population)., Methods: In this 3-phase study, Phases 1 and 2 included a cross-discipline concept analysis of the preparedness construct, item generation for patient and surrogate scales (82 items), evaluation of content validity and readability, cognitive interviewing, and item reduction. In phase 3, the retained 26 patient and 25 surrogate items were administered to 426 patients and 426 surrogates during a multisite trial of an ACP intervention versus care-as-usual and evaluated internal consistency, 2-week test-retest reliability, and construct validity., Results: Scales were reduced to 20 patient and 19 surrogate items during phase 3. Cronbach's alphas were 0.86 (patient) and 0.90 (surrogate). There was a strong correlation between preparedness at baseline and two weeks for both scales (r = 0.66-0.69, P < 0.001). Confirmatory factor analysis and item-response analyses suggested unidimensionality. A significant correlation was shown between patient preparedness and patient decisional conflict (r = -0.53, P < 0.001), and surrogate preparedness and surrogate decision-making confidence (r = 0.44, P < 0.001). Among those who received the ACP intervention, the effect size of change was medium: Cohen's d = 0.54, P < 0.001 for patients and d = 0.57, P < 0.001 for surrogates., Conclusions: The preparedness scales demonstrated strong psychometric properties. Future studies should examine scale performance in other populations., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: A purpose-built outcome measure for assessing communication effectiveness in patients with an artificial airway is needed., Objectives: The objective of this study was to develop the Communication with an Artificial airway Tool (CAT) and to test the feasibility and to preliminary evaluate the clinical metrics of the tool., Methods: Eligible patients with an artificial airway in the Intensive Care Unit were enrolled in the pilot study (Crit-CAT). The CAT was administered at least twice before and after the communication intervention. Item correlation analysis was performed. Participant and family member acceptability ratings and feedback were solicited. A qualitative thematic analysis was undertaken., Results: Fifteen patients with a mean age of 53 years (standard deviation [SD]: 19.26) were included. The clinician-reported scale was administered on 50 attempts (100%) with a mean completion time of 4.5 (SD: 0.77) minutes. The patient-reported scale was administered on 46 out of 49 attempts (94%) and took a mean of 1.5 (SD: 0.39) minutes to complete. The CAT was feasible for use in the Intensive Care Unit, with patients with either an endotracheal or tracheostomy tube, whilst receiving invasive mechanical ventilation or not, and while using either verbal or nonverbal modes of communication. Preliminary establishment of responsiveness, validity, and reliability was made. The tool was acceptable to participants and their family members., Conclusion: The clinician-reported and patient-reported components of the study were feasible for use. The CAT has the potential to enable quantifiable comparison of communication interventions for patients with an artificial airway. Future research is required to determine external validity and reliability., Competing Interests: Conflict of interest The authors declare no conflicts of interest associated with this study., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Sleep disruption is frequently observed in children with delirium in the pediatric intensive care unit (PICU)., Objectives: This observational pilot study explores relationships among modifiable characteristics of the PICU environment (i.e., light, sound, clinician caregiving patterns), sleep disruption, and delirium., Methods: Ten children, 1 to 4 years old, were recruited within 48 h of PICU admission and followed until discharge. A light meter, dosimeter, and video camera were placed at bedside to measure PICU environmental exposures. Sleep was measured via actigraphy. Twice daily delirium screening was conducted. Descriptive statistics were used to describe the PICU environment, sleep, and delirium experienced by children. Bivariate analyses were performed to determine relationships among variables., Results: Average participant age was 21 (SD = 9.6) months. Eight (80%) were admitted for respiratory failure. Median PICU length of stay was 36.7 (IQR[29.6, 51.5]) hours, which limited data collection duration. Delirium prevalence was 60% (n = 6). Children experienced low daytime light levels (x¯ = 112.8 lux, SD = 145.5) and frequent peaks (x¯ = 1.9/hr, SD = 0.5) of excessive sound (i.e., ≥ 45 A-weighted decibels). Clinician caregiving episodes were frequent (x¯ = 4.5/hr, SD = 2.6). Children experienced 7.3 (SD = 2.1) awakenings per hour of sleep and a median sleep episode duration of 1.4 (IQR[0.6, 2.3]) hours. On average, children with delirium experienced 1.1 more awakenings per sleep hour and 42 fewer minutes of sleep per sleep episode during the night shift. Increased clinician care frequency and duration were associated with worse sleep quality and delirium., Conclusions: Study results will inform future, large-scale research and nurse-driven sleep promotion interventions., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Laura Beth Kalvas reports financial support was provided by National Institutes of Health. Laura Beth Kalvas reports financial support was provided by American Association of Critical-Care Nurses. Laura Beth Kalvas reports financial support was provided by Sigma Theta Tau International. Laura Beth Kalvas reports financial support was provided by Council for the Advancement of Nursing Science. Laura Beth Kalvas reports financial support was provided by Midwest Nursing Research Society. Laura Beth Kalvas reports financial support was provided by Ohio Nurses Foundation. Nancy Redeker is the Editor of Heart & Lung., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Complementary health approaches have shown therapeutic benefits in symptom reduction and improved patients' quality of life for chronic debilitating conditions such as cancer and pulmonary hypertension. Urban Zen Integrative Therapy (UZIT) is a mindfulness-based multicomponent complementary intervention shown to improve symptom management and quality of life in patients with pulmonary hypertension. Consistent intervention delivery across interventionists is critical to test mindfulness-based multicomponent interventions on a larger scale and further implementations as an augmented practice in routine care., Objective: The purpose of the study is to explore interventionists' perspectives of UZIT delivery to gain an in-depth understanding of subjective interventionist-related variables that may influence intervention fidelity beyond objective measurements., Methods: Two trained Urban Zen Integrative Therapy interventionists provided their perspectives via joint interviews after delivering 78 one-on-one UZIT sessions to 14 pulmonary hypertension patients. A UZIT session incorporates essential oil, gentle movement, positioning, and meditation., Results: Qualitative analysis revealed four main contextual themes related to UZIT delivery adherence: (1) balancing between tailoring and standardization, (2) challenges with delivery, (3) the need for teamwork, and (4) clients' application of UZIT., Conclusion: When mindfulness-based complementary intervention is aimed at affecting behavioral health practice outcomes, comprehensive contextual insights from interventionists' point-of-view can enhance intervention fidelity and help researchers strengthen the conduct of rigorous research., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: To define effective communication and identify its key elements specific to critically ill patients with an artificial airway., Design: A modified Consensus Development Panel methodology., Setting: International video-conferences., Main Outcome Measures: Definition of effective communication and it's key elements., Results: Eight experts across four international regions and three professions agreed to form the Consensus Development Panel together with a Chair and one person with lived experience who reviewed the outputs prior to finalisation. "Communication for critically ill adult patients with an artificial airway (endotracheal or tracheostomy tube) is defined as the degree in which a patient can initiate, impart, receive, and understand information, and can range from an ineffective to effective exchange of basic to complex information between the patient and the communication partner(s). Effective communication encompasses seven key elements including: comprehension, quantity, rate, effort, duration, independence, and satisfaction. In critically ill adults, communication is impacted by factors including medical, physical and cognitive status, delirium, fatigue, emotional status, the communication partner and the nature of the ICU environment (e.g., staff wearing personal protective equipment, noisy equipment, bright lights)." The panel agreed that communication occurs on a continuum from ineffective to effective for basic and complex communication., Conclusion: We developed a definition and list of key elements which constitute effective communication for critically ill patients with an artificial airway. These can be used as the basis of standard terminology to support future research on the development of communication-related outcome measurement tools in this population., Implications for Clinical Practice: This study provides international multi-professional consensus terminology and a definition of effective communication which can be used in clinical practice. This standard definition and key elements of effective communication can be included in our clinical impressions of patient communication, and be used in discussion with the patient themselves, their families and the multi-professional team, to guide care, goal development and intervention., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background and Objectives: Caregiving is a social process and commonly involves more than a single caregiver, especially for older adults with multimorbidity, including dementia. This study was to characterize informal caregiving networks of older adults with dementia superimposed on multimorbidity (e.g., end-stage kidney disease) and to examine the relationships of network properties to outcomes of caregivers and older adults., Research Design and Methods: An egocentric social network survey was conducted. Up to 3 family caregivers of older adults on dialysis who had moderate-to-severe irreversible cognitive impairment with or without a documented diagnosis of dementia were recruited from 11 dialysis centers in 2 states. Caregivers completed a social network survey about individuals providing caregiving to the older adult and measures of caregiving burden and rewards, depression, and financial hardship. Older adults' emergency department visits and hospital admissions during the past 12 months were abstracted from the medical records., Results: A total of 76 caregiver informants of 46 older adults (78% Black) participated in the study. Of the 46 older adults, 65% had a multimember network (median size of 4). As the network density (the proportion of ties between members among all possible ties) increased, primary caregivers' financial hardship decreased whereas nonprimary caregivers' financial hardship increased. Further, for every 1-unit increase in mean degree (the average number of connections among members), there was a nearly fourfold increase in the odds of no hospital admission during the prior year for the older adult., Discussion and Implications: The network dynamics of informal caregiving networks may have an impact on the well-being of caregivers and older adults with dementia, but confirmatory longitudinal studies are needed., Competing Interests: Each author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Mechanically ventilated patients experience many adverse symptoms, such as anxiety, thirst, and dyspnea. However, these common symptoms are not included in practice guideline recommendations for routine assessment of mechanically ventilated patients. An American Thoracic Society-sponsored workshop with researchers and clinicians with expertise in critical care and symptom management was convened for a discussion of symptom assessment in mechanically ventilated patients. Members included nurses, physicians, a respiratory therapist, a speech-language pathologist, a critical care pharmacist, and a former intensive care unit patient. This report summarizes existing evidence and consensus among workshop participants regarding 1 ) symptoms that should be considered for routine assessment of adult patients receiving mechanical ventilation; 2 ) key symptom assessment principles; 3 ) strategies that support symptom assessment in nonvocal patients; and 4 ) areas for future clinical practice development and research. Systematic patient-centered assessment of multiple symptoms has great potential to minimize patient distress and improve the patient experience. A culture shift is necessary to promote ongoing holistic symptom assessment with valid and reliable instruments. This report represents our workgroup consensus on symptom assessment for mechanically ventilated patients. Future work should address how holistic, patient-centered symptom assessment can be embedded into clinical practice.

Aims: The aim of this study was to perform a concept analysis of communication with mechanically ventilated patients in intensive care units and present a preliminary model for communication practice with these patients., Design: The Im & Meleis approach for concept analysis guided the study., Search Methods: A literature search was performed in January 2022 in MEDLINE, Embase, CINAHL, psycINFO and Scopus, limited to 1998-2022. The main medical subject headings search terms used were artificial respiration, communication and critical care. The search resulted in 10,698 unique references., Review Methods: After a blinded review by two authors, 108 references were included. Core concepts and terminology related to communication with mechanically ventilated patients were defined by content analytic methods. The concepts were then grouped into main categories after proposing relationships between them. As a final step, a preliminary model for communication with mechanically ventilated patients was developed., Results: We identified 39 different phrases to describe the mechanically ventilated patient. A total of 60 relevant concepts describing the communication with mechanically ventilated patients in intensive care were identified. The concepts were categorized into five main categories in a conceptual map. The preliminary model encompasses the unique communication practice when interacting with mechanically ventilated patients in intensive care units., Conclusion: Highlighting different perspectives of the communication between mechanically ventilated patients and providers through concept analysis has contributed to a deeper understanding of the phenomena and the complexity of communication when the patients have limited possibilities to express themselves., Impact: A clear definition of concepts is needed in the further development of guidelines and recommendations for patient care in intensive care, as well as in future research. The preliminary model will be tested further., Patient or Public Contribution: No patient or public contribution, as this is a concept analysis of previous research., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Specialized education is critical for optimal insulin pump use but is not widely utilized or accessible. We aimed to (1) test the usability and acceptability of A1Control, a simulation platform supporting insulin pump education, and (2) determine predictors of performance., Method: Rural adult insulin pump users with type 1 diabetes (T1D) participated in a mixed methods usability study in 2 separate rounds. Participants navigated 3 simulations (ie, infusion site occlusion, hypoglycemia, exercise). Net Promoter Score (NPS) and Systems Usability Scale (SUS) were administered. Semi-structured interviews and direct observation were used to assess perceived usability, acceptability and performance. Synthetic Minority Oversampling Technique was used to fit predictive models for visualization of patterns leading to good or poor A1Control performance., Results: Participants ( N  = 13) were 28-70 years old, 10 used automated insulin delivery and 12 used continuous glucose monitoring (CGM). Mean NPS was 9.5 (range 9-10) and positive sentiment during interviews indicated very high acceptability. SUS (mean 88.5, range 70-100) indicted a high perceived usability. CGM percent wear ≥ 94%, time spent in hypoglycemia ≤ 54 mg/dl of <0.01%, and <70 mg/dl of 0.5% predicted successful site-occlusion scenario performance with 100% accuracy. BOLUS score ≥ 2, TDD ≥ 34, and technology brand predicted exercise scenario success with 100% accuracy. There were an insufficient number of failed hypoglycemia scenarios to assess predictors., Conclusion: A1Control shows potential to increase access and frequency of self-management and technology education. Additional study is needed to determine sustained engagement and benefit.

Delirium is a serious complication of pediatric critical illness. Sleep disruption is frequently observed in children with delirium, and circadian rhythm dysregulation is one proposed cause of delirium. Children admitted to the pediatric intensive care unit (PICU) experience multiple environmental exposures with the potential to disrupt sleep. Although researchers have measured PICU light and sound exposure, sleep, and delirium, these variables have not yet been fully explored in a single study. Furthermore, caregiving patterns have not often been included as a component of the PICU environment. Measuring the light and sound exposure, caregiving patterns, and sleep of critically ill children requires continuous PICU bedside data collection. This presents multiple methodological challenges. In this paper, we describe the protocol for an observational pilot study of the PICU environment, sleep, and delirium experienced by a sample of 10 critically ill children 1-4 years of age. We also evaluate and discuss the feasibility (i.e., acceptability, implementation, practicality) of the study protocol. Light and sound exposure were measured with bedside sensors. Caregiving was quantified through video recording. Sleep was measured via actigraphy and confirmed by video recording. Delirium screening with the Cornell Assessment of Pediatric Delirium was conducted twice daily, either in person or via video review. This study provides a refined measurement framework to inform future, large-scale studies and the development of nurse-driven sleep promotion interventions., (© 2022 Wiley Periodicals LLC.)