Dimensions and Role-Specific Mediators of Surrogate Trust in the ICU (original) (raw)
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Healthcare
Intensive care patients experience anxiety, pain, uncertainty, and total dependency. In general, it is important to develop trust between the healthcare professionals (HCPs), patients, and their family. Trust building in the ICU setting is challenging because of the time sensitivity of decision making and the dependency of patients on health care professionals. The objectives of this study are the development of a trust framework and then to use this framework in a case study in the intensive care. In three steps we developed a comprehensive trust framework from the literature concerning trust. First, we identified the elements of trust. Second, we adapted and integrated the dimensions to six concepts to construct the trust framework. Third, these concepts are incorporated into a comprehensive trust framework. In a case study we explored the facilitators and barriers within this framework in eight semi-open interviews with healthcare professionals and eight patients or partners. Tru...
Psycho-social medicine, 2012
Trust is an essential element in physician-patient interaction fostering in general adherence and improving patient- and physician-reported outcomes. Regarding severely injured patients, trust-building behaviour is important because of the severity of injuries and therefore potential associated physical and psychological consequences. The objective of this study was to identify significant and relevant determinants on trust of severely injured patients in their physicians in surgical intensive care units. Ninety-one severely injured patients completed a self-administered questionnaire after being transferred from surgical intensive care unit to surgical unit. All patients were treated in four hospitals of maximal care in North Rhine-Westphalia between 2001 and 2005. To assess different aspects of trust the "trust in physician" scale of the Cologne Patient Questionnaire (CPQ) was used. "Psychosocial care by physicians" is measured through: support, devotion, infor...
Relationships, trust, decision-making and quality of care in a paediatric intensive care unit
Intensive Care Medicine, 2009
Objective: To assess the care-giving practices of health-care practitioners in the paediatric intensive care unit (PICU) through their qualitative insights, reflections and experience in participatory action research. Design and methods: Qualitative research in the form of 'participatory action research' was used to gather data from three sources within the unit: focus groups within disciplines, observations within the PICU, and semi-structured interviews. All staff members were active collaborators and equal stakeholders in the decision-making process, research and feedback. Setting: The paediatric intensive care unit (PICU) of the Red Cross War Memorial Children's Hospital (RCWMCH). Participants: All staff members from various disciplines working in the PICU. Results: Staff members described problems with respect to relationships, trust and decisionmaking within care-giving practices. Conclusion: The study qualitatively describes how poor communication amongst staff members in respect of relationships and decision-making impacted on trust and how this tended to compromise care-giving practices in the PICU. The data suggested that this was more evident in informal rather than formal clinical decisionmaking procedures. The strength of the study was that the participatory action design in the research allowed staff members to address the very dynamics that they themselves cited as problematic.
Journal of Critical Care, 2017
Purpose: To examine how tele-ICU nurse characteristics and organizational characteristics influence tele-ICU nurses' trust and satisfaction of monitored bedside ICU nurses, and whether these influences are mediated by communication. Materials and Methods: Data of tele-ICU characteristics and characteristics of the ICUs they monitored were collected at 5 tele-ICUs located throughout the country. 110 tele-ICU nurses at those tele-ICUs completed a questionnaire containing items related to their characteristics and their trust, satisfaction, and perceived communication with monitored bedside nurses. We analyzed the data using a hierarchical path model, with communication variables entered as mediators. Results: Many of the tele-ICU nurse characteristics (age, currently or previously worked at the monitored ICU, hours worked per week, and years as a ICU nurse) had statistically significant direct effects on perception of communication timeliness, accuracy, and openness, as well as trust and satisfaction with monitored bedside ICU nurses. Communication openness mediated the relationships of both working at a monitored ICU and being older (≥55) on satisfaction. Communication accuracy mediated the relationships of both a specialized monitored ICU and working at a monitored ICU on trust. Conclusions: Tele-ICUs and monitored ICUs should work to optimize communication so that trust can be established among the nurses.
Various dimensions of trust in the health care system
Emergency Medical Service, 2020
Trust is one of the most important factors in building effective and long-lasting relationships in the entire healthcare sector. Trust becomes a valuable ally in situations of high risk and uncertainty as well as the increasing complexity of tasks that accompany the daily work of all medical professionals, especially paramedics, due to the nature of their work in the medical rescue system. Mutual trust is the basis of social capital thanks to which it is possible to achieve mutual benefits, easier to coordinate activities, create new quality and solutions through cooperation or strong ties. It is a kind of glue that binds various organizational and system links, thanks to which it is easier to plan and introduce necessary improvements and changes within individual medical units or the entire health care system. The high degree of trust increases the quality of clinical communication with the patient and the effectiveness of medical care and strengthens the employees’ motivation and ...
Trust between nursing management and staff in critical care: a literature review
Aim: This paper aims to provide a comprehensive review of the topic of trust between nurses and nurse managers in the context of critical care units. Method: A comprehensive literature review exploring the concept of trust between nurse and nurse managers was undertaken. Search terms were used both singularly and in combination and 71 relevant citations were found. Abstracts were read and in total 20 peer reviewed articles were retained as a result of consistency with project aims. Results: Trust emerged as an essential component in the nurse-patient relationship. However, trust among staff and management received little attention. Conclusions: Trust emerges as an important attribute of effective nurse managers. Nurse managers need to appreciate the importance of fostering a trustworthy relationship with subordinates. Engendering trust between management and staff empowers staff and has positive organizational outcomes.
Annals of the American Thoracic Society, 2016
Intensive care unit (ICU) patients' expected post-discharge outcomes are rarely discussed in family meetings despite this information being centrally important to patients and their families. To characterize intensivist-identified barriers and facilitators to discussing postdischarge outcomes with surrogates of ICU patients. Qualitative study conducted via one-on-one, semi-structured telephone interviews with 23 intensivists from 20 hospitals with accreditation council for graduate medical education accredited critical care medicine programs in 16 states. A limited application of grounded theory methods were used to code transcribed interviews and identify themes and illustrative quotes. Intensivists reported tension between their professional responsibility to discuss likely functional outcomes versus uncertainty about their ability to predict those outcomes in an individual patient. They cited three main barriers as limiting their ability to conduct conversations about post-di...
Decision-making in the ICU: perspectives of the substitute decision-maker
Intensive care medicine, 2003
To describe the substitute decision-makers' perspectives related to decision-making in the intensive care unit (ICU) and to determine those variables associated with their overall satisfaction with decision-making. Prospective, multicenter, cohort study. Six Canadian university-affiliated ICUs. We distributed a validated, self-administered questionnaire assessing 21 key aspects of communication and decision-making to substitute decision-makers of ICU patients who were mechanically ventilated for more than 48 h. None. A group consisting of 1,123 substitute decision-makers received questionnaires; 789 were returned (70.3% response rate). Respondents were most satisfied with the frequency of communication with nurses and least satisfied with the frequency of communication with physicians. In terms of overall satisfaction with decision-making, 560 (70.9%) of the respondents were either completely or very satisfied. The majority (81.2%) of respondents preferred some form of shared de...