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      Perspectives from designated family caregivers of critically ill adult patients during the COVID-19 pandemic: A qualitative interview study

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          Abstract

          Background

          Family visitation in intensive care units (ICU) has been impacted by the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic. While studies report on perceptions of families completely restricted from ICUs, little is known about the burden experienced by designated family caregivers allowed to visit their critically ill loved one. This study sought the perspectives of family caregivers of critically ill patients on the impact of one-person designated visitor policies mandated in ICUs during the COVID-19 pandemic.

          Methods

          Throughout the study period a restricted visitation policy was mandated capturing the first (April 2020) and second (December 2020) waves of the pandemic that allowed one designated family caregiver (i.e., spouses or adult children) per patient to visit the ICU. Designated family caregivers of critically ill patients admitted to ICU September 2020 to November 2020 took part in individual 60-minute, semi-structured interviews at 6-months after discharge from the index ICU admission. Themes from family interviews were summarized with representative quotations.

          Results

          Key themes identified following thematic analysis from six participants included: one visitor rule, patient advocate role, information needs, emotional distress, strategies for coping with challenges, practicing empathy, and appreciation of growth.

          Conclusion

          Designated family caregivers of critically ill patients admitted to ICU during the COVID-19 pandemic perceived a complex and highly stressful experience. Support from ICU family liaisons and psychologists may help ameliorate the impact.

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          Most cited references66

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough?

            Saturation is a core guiding principle to determine sample sizes in qualitative research, yet little methodological research exists on parameters that influence saturation. Our study compared two approaches to assessing saturation: code saturation and meaning saturation. We examined sample sizes needed to reach saturation in each approach, what saturation meant, and how to assess saturation. Examining 25 in-depth interviews, we found that code saturation was reached at nine interviews, whereby the range of thematic issues was identified. However, 16 to 24 interviews were needed to reach meaning saturation where we developed a richly textured understanding of issues. Thus, code saturation may indicate when researchers have "heard it all," but meaning saturation is needed to "understand it all." We used our results to develop parameters that influence saturation, which may be used to estimate sample sizes for qualitative research proposals or to document in publications the grounds on which saturation was achieved.
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              What's in a name? Qualitative description revisited.

              "Whatever Happened to Qualitative Description?" (Sandelowski, 2000) was written to critique the prevailing tendency in qualitative health research to claim the use of methods that were not actually used and to clarify a methodological approach rarely identified as a distinctive method. The article has generated several misconceptions, most notably that qualitative description requires no interpretation of data. At the root of these misconceptions is the persistent challenge of defining qualitative research methods. Qualitative description is a "distributed residual category" (Bowker & Star, 2000). Cambridge, MA: The MIT Press) in the classification of these methods. Its value lies not only in the knowledge its use can produce, but also as a vehicle for presenting and treating research methods as living entities that resist simple classification.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 September 2022
                2022
                27 September 2022
                : 17
                : 9
                : e0275310
                Affiliations
                [1 ] Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
                [2 ] Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
                [3 ] O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
                [4 ] Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
                [5 ] Alberta Health Services, Edmonton, Alberta, Canada
                [6 ] Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
                [7 ] Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
                University of Montreal, CANADA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-1157-884X
                https://orcid.org/0000-0002-8576-9139
                https://orcid.org/0000-0002-7299-6594
                Article
                PONE-D-21-35872
                10.1371/journal.pone.0275310
                9514636
                36166458
                9d8081e5-34fb-41b4-bafb-f7e14df96e80
                © 2022 Moss et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 November 2021
                : 13 September 2022
                Page count
                Figures: 1, Tables: 2, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award ID: Doctoral Research Award
                Award Recipient :
                SJM was supported by a Canadian Institutes of Health Research Doctoral Research Award. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could have influenced the submitted work.
                Categories
                Research Article
                Medicine and Health Sciences
                Health Care
                Caregivers
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Hospitals
                Intensive Care Units
                Social Sciences
                Sociology
                Human Families
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Health Care
                Patients
                Biology and Life Sciences
                Psychology
                Emotions
                Social Sciences
                Psychology
                Emotions
                Medicine and Health Sciences
                Health Care
                Patient Advocacy
                Custom metadata
                Data cannot be shared publicly because of ethical restriction (i.e., patient confidentiality; data contains potentially sensitive information). Data may be available upon reasonable request from the University of Calgary Conjoint Health Research Ethics Board and Alberta Health Services research and innovation administration (contact via chreb@ 123456ucalgary.ca and research.administration@ 123456ahs.ca ) for researchers who meet the criteria for access to confidential data.
                COVID-19

                Uncategorized
                Uncategorized

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