NURSING SENSITIVE OUTCOMES IN INTENSIVE CARE UNIT. A FOCUS ON THE FAMILY ENGAGEMENT IN HEALTHCARE

Driven by the current need of achieving high-reliability and patient-focused organization, several efforts have been enacted with the purpose of identifying and qualifying nursing care’s contribution to patients’ outcomes in Intensive Care Unit (ICU). The main aim of this thesis was to advance knowledge in critical care nursing with regard to nursing outcomes in the ICU. Thirty-five Nursing Sensitive Outcomes (NSOs) have been identified from a scoping review. Pressure ulcers, ventilator-associated pneumonia, and physiological parameter changes have been the top three reported outcomes, while those related to the physical dimension (such as bowel status) and the experience of being in intensive care (such as family participation in care) have been rarely reported. In addition, as an expression of both the structural and process dimensions of care, a total of 21 nursing factors have been studied to date. Early mobility programmes, the use of algorithms, checklists and specific assessment tools, nurse staffing and compliance with care bundles have been largely studied as being able to affect NSOs in the ICU. Conversely, little research investigating family member’s contributions to care in ICU, including its outcomes on family itself and on patient care, has been rendered available. Thus, the aim of the Family ENgagement in Intensive Care Environments (FENICE) project was to assess the effects of a family engagement program on family members’ satisfaction and on patients’ well-being and quality of life post-discharge. When questioned, relatives of critically ill patients discharged from an ICU experienced a mix of negative and positive feelings in the early stages. Three main themes summarized the experience of relatives in the first three months after ICU discharge: ‘Being shaken following ICU discharge’; ‘Returning to our life that is no longer what it used to be’ and ‘Feeling powerless due to the COVID-19 pandemic’. Finally, from an educational perspective, ICUs were perceived as good learning environments where undergraduate nursing students reported learning a high degree of competences compared with other clinical rotations. Therefore, this context of care can promote positive attitudes regarding the NSOs, by moving nursing care from a task orientation to an outcomes focus since the undergraduate education.