“It’s all about setting the stage.” The nurse facilitator trial: perceived outcomes and implementation issues. A qualitative study among ICU clinicians and nurse facilitators,Intensive Care Medicine

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“It’s all about setting the stage.” The nurse facilitator trial: perceived outcomes and implementation issues. A qualitative study among ICU clinicians and nurse facilitators
Intensive Care Medicine ( IF 27.1 ) Pub Date : 2024-08-19 , DOI: 10.1007/s00134-024-07589-z
Anne Renet ₁ , Elie Azoulay _{1,

2} , Jean Reignier ₃ , Alain Cariou _{2,

4} , Anne Renault ₅ , Olivier Huet ₆ , Frédéric Pochard ₁ , Ruth A Engelberg ₇ , Nancy Kentish-Barnes ₁

Affiliation

Purpose

For the first time in France, a randomised controlled trial was conducted to evaluate the impact of a nurse facilitator on family psychological symptoms. We sought to explore the implementation of the intervention, how it was experienced by clinicians, as well as the barriers and facilitators to implementing the change.

Methods

We conducted qualitative semi-structured interviews with intensive care unit (ICU) clinicians and facilitators involved in the trial. Interview questions focused on participants’ perceptions of the intervention and its outcomes, including the effect of the intervention on patients, families and the health care team, and barriers and facilitators to its implementation. Interviews were conducted by two social science researchers, audio recorded, transcribed, and analyzed using thematic content analysis.

Results

Twenty-three clinicians were interviewed from the five participating ICUs. Three themes emerged, capturing clinicians’ perspectives on implementing the intervention: (1) improved communication and enhanced care for families and the ICU team, albeit with some associated risks; (2) active listening and support, both for families and ICU clinicians but with certain limitations; (3) barriers to implementation including lack of organizational readiness, exclusion of under-represented groups, and facilitator challenges including role ambiguity and the need for role support.

Conclusion

Participants believed the facilitator intervention potentially improved families’ experience. However, they also highlighted emotional difficulties and tensions with some members of the participating teams, due to competing territories and ambiguous role definitions. Facilitators' failure to affect decision-making suggests their role in enhancing goal-concordant care was inadequate within the setting.

中文翻译：

“这一切都是为了搭建舞台。”护士促进者试验：感知结果和实施问题。ICU 临床医生和护士辅导员的定性研究

目的

在法国，首次进行了一项随机对照试验，以评估护士辅导员对家庭心理症状的影响。我们试图探索干预措施的实施情况、临床医生的感受以及实施变革的障碍和促进因素。

方法

我们对参与试验的重症监护病房（ICU）临床医生和促进者进行了定性半结构化访谈。访谈问题侧重于参与者对干预及其结果的看法，包括干预对患者、家庭和医疗保健团队的影响，以及实施干预的障碍和促进因素。访谈由两名社会科学研究人员进行，录音、转录并使用主题内容分析进行分析。

结果

来自五个参与 ICU 的 23 名临床医生接受了采访。出现了三个主题，捕捉了临床医生对实施干预措施的看法：（1）改善沟通并加强对家庭和 ICU 团队的护理，尽管存在一些相关风险;（2）积极倾听和支持，无论是针对家庭还是 ICU 临床医生，但有一定的局限性;（3）实施障碍，包括缺乏组织准备、排除代表性不足的群体，以及促进者挑战，包括角色模糊和需要角色支持。