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      Engaging the Public to Identify Opportunities to Improve Critical Care: A Qualitative Analysis of an Open Community Forum

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          Abstract

          Objective

          To engage the public to understand how to improve the care of critically ill patients.

          Design

          A qualitative content analysis of an open community forum (Café Scientifique).

          Setting

          Public venue in Calgary, Alberta, Canada.

          Participants

          Members of the general public including patients, families of patients, health care providers, and members of the community at large.

          Methods

          A panel of researchers, decision-makers, and a family member led a Café Scientifique, an informal dialogue between the populace and experts, over three-hours to engage the public to understand how to improve the care of critically ill patients. Conventional qualitative content analysis was used to analyze the data. The inductive analysis occurred in three phases: coding, categorizing, and developing themes.

          Results

          Thirty-eight members of the public (former ICU patients, family members of patients, providers, community members) attended. Participants focused the discussion and provided concrete suggestions for improvement around communication (family as surrogate voice, timing of conversations, decision tools) and provider well-being and engagement, as opposed to medical interventions in critical care.

          Conclusions

          Café participants believe patient and family centered care is important to ensure high-quality care in the ICU. A Café Scientifique is a valuable forum to engage the public to contribute to priority setting areas for research in critical care, as well as a platform to share lived experience. Research stakeholders including health care organizations, governments, and funding organizations should provide more opportunities for the public to engage in meaningful conversations about how to best improve healthcare.

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          Most cited references27

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          Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study.

          Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserves that confers vulnerability to adverse outcomes. We determined the prevalence, correlates and outcomes associated with frailty among adults admitted to intensive care. We prospectively enrolled 421 critically ill adults aged 50 or more at 6 hospitals across the province of Alberta. The primary exposure was frailty, defined by a score greater than 4 on the Clinical Frailty Scale. The primary outcome measure was in-hospital mortality. Secondary outcome measures included adverse events, 1-year mortality and quality of life. The prevalence of frailty was 32.8% (95% confidence interval [CI] 28.3%-37.5%). Frail patients were older, were more likely to be female, and had more comorbidities and greater functional dependence than those who were not frail. In-hospital mortality was higher among frail patients than among non-frail patients (32% v. 16%; adjusted odds ratio [OR] 1.81, 95% CI 1.09-3.01) and remained higher at 1 year (48% v. 25%; adjusted hazard ratio 1.82, 95% CI 1.28-2.60). Major adverse events were more common among frail patients (39% v. 29%; OR 1.54, 95% CI 1.01-2.37). Compared with nonfrail survivors, frail survivors were more likely to become functionally dependent (71% v. 52%; OR 2.25, 95% CI 1.03-4.89), had significantly lower quality of life and were more often readmitted to hospital (56% v. 39%; OR 1.98, 95% CI 1.22-3.23) in the 12 months following enrolment. Frailty was common among critically ill adults aged 50 and older and identified a population at increased risk of adverse events, morbidity and mortality. Diagnosis of frailty could improve prognostication and identify a vulnerable population that might benefit from follow-up and intervention.
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            • Article: not found

            Nurse moral distress: a proposed theory and research agenda.

            As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.
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              • Article: not found

              Doctors' perceptions of the links between stress and lowered clinical care.

              We know from numerous industrial studies that stress, particularly in the form of tiredness and sleep deprivation, has a detrimental effect upon work performance, though this is not so clear-cut in studies of doctors, despite their stress levels being particularly high. This study explores the doctors' views on this using anonymous questionnaires from a population of 225 hospital doctors and general practitioners, 82 of whom reported recent incidents where they considered that symptoms of stress had negatively affected their patient care. The qualitative accounts they gave were coded for the attribution (type of stress symptom) made, and the effect it had. Half of these effects concerned lowered standards of care; 40% were the expression of irritability or anger; 7% were serious mistakes which still avoided directly leading to death; and two resulted in patient death. The attributions given for these were largely to do with tiredness (57%) and the pressure of overwork (28%), followed by depression or anxiety (8%), and the effects of alcohol (5%). The data are discussed in terms of the links made by the doctors between their fatigue or work pressure and the way they care for patients. It presumes that these incidents had been previously unreported and talks about the effects this secrecy has on the emotional state of the doctors concerned. It offers ways forward for tackling the problem, of interest to the profession, managers and commissioners.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 November 2015
                2015
                : 10
                : 11
                : e0143088
                Affiliations
                [1 ]Research Priorities & Implementation, Alberta Health Services, Calgary, Canada
                [2 ]Department of Community Health Sciences, University of Calgary, Calgary, Canada
                [3 ]W21C Research and Innovation Centre, University of Calgary, Calgary, Canada
                [4 ]Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta Health Services, Edmonton, Canada
                [5 ]Department of Critical Care Medicine, Queen’s University, Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Canada
                [6 ]Family Advisor, Critical Care, Alberta Health Services, Calgary, Canada
                [7 ]Patient and Community Engagement Researcher (PaCER), University of Calgary, Calgary, Canada
                [8 ]Department of Critical Care Medicine, University of Calgary, Alberta Health Services, Calgary, Canada
                University of Tübingen, GERMANY
                Author notes

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

                Conceived and designed the experiments: HTS. Performed the experiments: MLP JB SMB DH PO CJD DZ HTS. Analyzed the data: MLP JB. Contributed reagents/materials/analysis tools: MLP JB SMB DH PO CJD DZ HTS. Wrote the paper: MLP JB. Revised the manuscript critically for important intellectual content: MLP JB SMB DH PO CJD DZ HTS.

                Article
                PONE-D-15-27522
                10.1371/journal.pone.0143088
                4651489
                26580406
                dab825e9-931d-48d3-8cac-e1abbace0c46
                Copyright @ 2015

                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
                : 23 June 2015
                : 17 October 2015
                Page count
                Figures: 0, Tables: 0, Pages: 11
                Funding
                This work was supported by an operating grant from Canadian Institutes of Health Research (SCI-131811). The funder had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.
                Categories
                Research Article
                Custom metadata
                Due to ethical restrictions related to protecting patient privacy imposed by the University of Calgary Conjoint Health Research Ethics Board, the full, qualitative dataset (i.e. interview transcripts) cannot be made publicly available. This dataset is available upon request to the corresponding author and relevant excerpts from these transcripts are included in the paper and Supporting Information files.

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