Engagement with patients and families about managing medications in critical care units: A mixed methods systematic review

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care Pub Date : 2025-06-12 DOI:10.1016/j.aucc.2025.101267

Elizabeth Manias RN, BPharm, MPharm, MNStud, PhD, DLF-ACN, FAAN, FACCCN, FANZCAP Transitions of Care, Geriatric Medicine , Rebecca Jarden RN, PhD , Kelly Ottosen BN(Hons), MHealthSc(Nurs), RN, PhD , Pauline Wong RN, CCRN, MHthSc, MACN , Philip Peter RN, RM, CCRN, PICNC, BCom Eco, MHthSc, MProfEd&Tmg, MClNse, GCHealthMgt Safe&Qual, GCHealthAdmin, MACN , Sharron Curnow RN, BN , Malcolm Elliott RN, PhD , Frances Lin RN, PhD, FACCCN

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引用次数: 0

Abstract

Objective

The objective of this study was to examine how patients and families are engaged in managing medications in critical care units.

Review method used

A mixed methods systematic review was conducted.

Data sources

A search was conducted of five library databases from inception to January 27, 2024, and updated on September 20, 2024, comprising MEDLINE(R) ALL (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), Embase (Ovid), and the Cochrane Central Register of Controlled Trials (CENTRAL) (Ovid).

Review methods

Screening, data abstraction, and quality assessments were completed independently and in duplicate. Included studies were mapped onto a continuum across three levels of engagement, which were consultation, involvement, and partnership and shared leadership.

Results

There were 30 studies included. Patients and families were largely engaged through information exchange with health professionals. Patients valued intensive care unit nurses communicating with them as they performed medication activities at the bedside. This communication was considered important regardless of the patients' conscious state. Opportunities for involvement occurred when health professionals asked about patients' and families' needs and preferences for medications. This involvement helped to address symptoms such as pain and anxiety, especially as the patients’ condition improved. There were isolated situations where patients and families were involved in partnerships comprising active decision-making. Interactions between health professionals about medication management during handovers, ward rounds, and informal conversations largely excluded patients and families. Interventional studies had a tenuous focus on patient and family engagement and demonstrated little impact on medication quality and safety.

Conclusions

Patients and families faced power differentials, environmental barriers, and unwavering views about their capabilities to be involved about medication management. Many of the situations identified in included studies can be addressed by improving communication opportunities with the healthcare team. Family members can be included in bedside rounds, be allowed to remain present during procedures, and be provided with a routine scheduled opportunity for discussion.

查看原文本刊更多论文

参与病人和家属在重症监护病房的药物管理：一项混合方法的系统回顾

目的本研究的目的是检查患者和家属是如何参与管理药物在重症监护病房。评价方法采用eda混合方法进行系统评价。数据来源检索了从建立到2024年1月27日，并于2024年9月20日更新的五个图书馆数据库，包括MEDLINE(R) ALL （Ovid）、CINAHL Complete （EBSCOhost）、PsycINFO （Ovid）、Embase （Ovid）和Cochrane Central Register of Controlled Trials (Central) （Ovid）。筛选、数据提取和质量评估独立完成，一式两份。纳入的研究被映射到三个参与水平的连续体上，这三个参与水平是咨询、参与、伙伴关系和共同领导。结果共纳入30项研究。患者和家属主要通过与保健专业人员交流信息而参与其中。患者重视重症监护室护士在床边进行药物治疗活动时与他们的沟通。无论患者的意识状态如何，这种交流都被认为是重要的。当卫生专业人员询问患者和家属对药物的需求和偏好时，就有机会参与其中。这种参与有助于解决疼痛和焦虑等症状，特别是在患者病情改善时。在个别情况下，病人和家属参与了包括积极决策在内的伙伴关系。在交接、查房和非正式谈话期间，卫生专业人员之间关于药物管理的互动在很大程度上排除了患者和家属。介入性研究对患者和家庭参与的关注不够，对药物质量和安全性的影响很小。结论患者和家属在参与药物管理的能力方面存在权力差异、环境障碍和不确定性。纳入研究中确定的许多情况可以通过改善与医疗团队的沟通机会来解决。家庭成员可以参与床边查房，允许在手术过程中留在身边，并提供常规安排的讨论机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Australian Critical Care NURSING-NURSING

CiteScore

4.90

自引率

9.10%

发文量

148

审稿时长

>12 weeks

期刊介绍： Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.