supporting families through discharge from picu to the ward: the development and evaluation of a...
TRANSCRIPT
Intensive and Critical Care Nursing (2008) 24, 329—337
ORIGINAL ARTICLE
Supporting families through discharge from PICUto the ward: The development and evaluation ofa discharge information brochurefor families
Sophie Linton ∗, Chelsea Grant1, Juliet Pellegrini1
PICU Liaison Nurse, c/o Intensive Care Unit, Royal Children’s Hospital,Flemington Road, Parkville 3052, Australia
Accepted 15 June 2008
KEYWORDSTransfer anxiety;Discharge information;Nurse liaison
SummaryIntroduction: Discharge from paediatric ICU and transfer to the ward can evoke fearand anxiety. Along with the introduction of the ICU liaison nurse role, the litera-ture suggests that the provision of written information has the greatest potential toreduce transfer anxiety. This paper will discuss the issues associated with dischargefrom a paediatric ICU, the process of identifying the information needs of families,the development of a written brochure and evaluation of the brochure in practice.Results: Evaluation of the ‘discharge from ICU’ brochure found, 95% of parentsbelieved the brochure was easy to read, understand and helpful in improving theirunderstanding of what to expect on the ward. 95% also found it useful to havethe transfer ward details written down prior to leaving the PICU. 85% agreed thebrochure helped to answer their questions in relation to the transfer.Conclusion: The introduction of a brochure explaining the process of discharge fromICU and what to expect on the wards received positive feedback from families. Thebrochure provides families with generic information regarding ICU transfer, how-
ever, it is important for the ICU liaison nurse to promote discussion and tailor theinformation for the particular experiences and needs of each patient and familysituation.Crown Copyright © 2008 Pu∗ Corresponding author. Tel.: +61 3 9345 5211; fax: +61 3 93456960.
E-mail addresses: [email protected] (S. Linton),[email protected] (C. Grant),[email protected] (J. Pellegrini).
1 Tel.: +61 3 9345 5211; fax: +61 3 9345 6960.
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0964-3397/$ — see front matter. Crown Copyright © 2008 Published bdoi:10.1016/j.iccn.2008.06.002
blished by Elsevier Ltd. All rights reserved.
ntroduction
t is recognised that the admission of a child to anntensive care unit (ICU) is a stressful experienceor families. However, with time the child and fam-ly may adjust and become desensitised to the ICU
y Elsevier Ltd. All rights reserved.
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environment and they can even become reassuredand comforted by the high levels of ICU resourcesincluding technology, monitoring and staffing. Anx-iety may significantly increase in the period arounddischarge from ICU to the ward (Coyle, 2001). Fam-ilies may be anxious about leaving the familiarityand security of ICU despite assurances that dis-charge from ICU is a positive step in the child’srecovery. Caffin (2005) found 53% of parents feltthat leaving ICU and moving to a new environmentmade them anxious.
The plan of care around discharge may seemcomplex and daunting to families. McKinney andDeeny (2002) found that there is an inverse rela-tionship between the length of time a patient isaware of impending transfer prior to the moveand the intensity of stress and transfer anxi-ety. If children and particularly parents are notaware of or do not understand the plan of carethey can be afraid, uncertain and anxious; theymay even express dissatisfaction and anger. Chil-dren quickly pick up on their parent’s emotionsand may respond in ways that affect their recov-ery.
The role of the PICU liaison nurse (LN) was intro-duced at the Royal Children’s Hospital in 2004 tobridge the gap between the paediatric intensivecare unit (ICU) and the wards. The role aims toimprove continuity of care through the continuumof illness. The liaison nurse allows for an extensionof ICU nursing practice onto the wards and also pro-vides a familiar face and link with ICU for families.The main role of the liaison nurse is to offer sup-port to patients and families and advanced nurseconsultancy for staff during the transition phaseassociated with the discharge of a child from ICUto the ward.
Effective communication with families is a corecomponent of support and increasingly the respon-sibility of nurses. The importance of both verbaland written discharge information for parents andfamilies has been well documented (Mitchell andCourtney, 2005; Paul et al., 2004; Kenny et al.,1998). From our anecdotal experience in the liai-son role we identified a need for the developmentof a written material to facilitate the discussion andsupport provided by the ICU liaison nurse during thedischarge process.
This paper will discuss the introduction ofa ‘Discharge from the Intensive Care Unit tothe Ward’ information brochure for parents.
Following a review of the literature we willdescribe the process of identifying the informa-tion needs of families, the design process of thebrochure and the evaluation of the impact of suchinformation.efIio
S. Linton et al.
iterature review
uch of what we know in relation to the topic ofischarge from ICU to the ward comes from adultata. We focused our search on papers from pae-iatric settings but as this was very limited, weave included several adult papers. A number ofhe issues raised in the adult population are perti-ent for children and their families in relation tohe issues associated with the transition from ICUo the ward.
ransfer anxiety
ransfer from the ICU to the ward is recognised toe a traumatic time for the family, particularly ifhe patient is a child recovering from critical ill-ess (Van Waning et al., 2005). The patient maye physically ready for discharge from ICU buthey and their family may not be psychologicallyrepared.
Coyle (2001) and McKinney and Melby (2002)dentify a phenomenon of ‘transfer anxiety’ orrelocation stress’ and Leith (1998) further includeshe terms, transfer trauma, translocation syn-rome, transplantation shock, relocation stress,elocation syndrome, relocation trauma and sepa-ation anxiety. This includes but is not limited tohe experience of patients and their families whenischarged from ICU to the ward. Transfer anxi-ty can defined as ‘‘a state in which an individualxperiences physiological and/or psychosocial dis-urbances as a result of transfer from a familiarnvironment to another that is unfamiliar’’ (Leith,998, p. 24)
Transfer out of ICU is identified as one of theost stressful aspects of hospitalisation (Chaboyer,
006). Coyle (2001) suggests that discharge fromCU can be as traumatic as admission. This providesistinctive challenges for patients, their familynd the health care professionals involved in theatient’s care (Chaboyer et al., 2005b).
The ICU environment is unique with numbers ofritically ill patients, a multitude of invasive com-lex technology, continuous observation, intensiveonitoring and high levels of staffing both medical
nd nursing. In comparison, on the wards patientsnd families quickly become aware of a lack of pres-nce of nurses and a dramatic decrease in the levelf attention (McKinney and Melby, 2002). In theirmall scale phenomenological study of the experi-
nce of leaving the ICU McKinney and Deeny (2002)ound many comments in relation to the staff inCU were overwhelmingly positive and that ‘leav-ng the ICU staff was the most negative componentf transfer’ (p. 26).
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evelopment and evaluation of a discharge informa
Leith (1998) refers to Freud’s theory of sep-ration anxiety — initially used to describe thenxiety experienced by children separated fromheir mothers — and postulates that these patientsay experience anxiety because of the loss of a
lose relationship with their doctors and nursesollowing transfer from ICU, in conjunction withncertainty about the unfamiliar ward environmenthis can lead to stress and reduced coping abili-ies. Coyle (2001) identifies that patients may viewischarge from ICU with insecurity and perceivehe experience as abandonment or rejection ratherhan as a positive step forward to recovery.
An understanding of the culture and customsithin a hospital and the differences between theards and ICU becomes routine for nurses, and it
s easy to forget how small changes can make aig difference for children and their families (Vananing et al., 2005). Despite the improving healthf the patient, fear is associated with moving fromne area to another (Whittaker and Ball, 2000).atients who have been in ICU for a longer periodre considered to have higher levels of transfer anx-ety possibly related to the greater level of rapporteveloped between the family and ICU staff andadvanced level of understanding and degree of
omfort within the ICU environment (Leith, 1998).Compromised transitional care and elevated lev-
ls of transfer anxiety can manifest itself in bothhort- and long-term physical and psychologicalutcomes (Whittaker and Ball, 2000; McKinneynd Melby, 2002), potentially leading to delayedecovery, increased length of hospital stay, read-ission to ICU and associated increased rates ofortality (Chaboyer et al., 2005a; McKinney andelby, 2002). In their phenomenological study of
ix patients’ experience of discharge from ICU,cKinney and Deeny (2002) describe that theajority of patients were suffering some degree
f physical problems. The predominant complaintsncluded pain, sleeping difficulties, weakness, lim-ted mobility and loss of appetite. Although only
small scale study in an adult population, theirndings may be applicable for both the child andamily in the paediatric population although thisould require further investigation.There is a need to implement appropriate
ursing strategies to reduce transfer anxiety andrepare patients and families for transition fromCU to the ward (Chaboyer et al., 2005b). Recognis-ng and acknowledging the experience of transfer
nxiety as normal and managing the process isital (Coyle, 2001). Nursing interventions aimed ateducing stress associated with transfer from ICUo the wards include reinforcing the discharge aspositive move (Whittaker and Ball, 2000), and
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brochure for families 331
ncouraging it as an important step in the recov-ry process (Coyle, 2001). For families who havead prolonged stays in ICU this involves carefullanning and co-ordination. Chaboyer et al. (2005a)uggest a range of clinical interventions to reducehe impact and potential complications associatedith the transition from ICU to the wards includingischarge planning in ICU, ICU liaison nurses andtep down units. Leith (1998) outlined other possi-le interventions including informing patients andheir families of transfer plans in advance, involvingatient’s families in planning for transfer, planningor daytime transfer, promoting transfer as a sign ofrogress, encouraging patients and families to askuestions and keeping patients and families up toate with clinical progress. Explanation and edu-ation about why a child is being transferred isnstrumental in easing fear and anxiety (Van Waningt al., 2005).
ole of the ICU liaison nurse in theischarge from ICU to the wards
he introduction of the specialist ICU liaison nurses a strategy to improve communication betweenCU and the wards and provide enhanced con-inuity and quality of care for patients duringischarge from ICU to the wards. Multiple aspectsf the ICU liaison nurses role may contribute tohe reduction of transition anxiety for patients andheir families discharged from ICU. This includeseeting the family prior to discharge, timely noti-cation of the potential transfer for both the wardtaff and family, assessment and understanding ofamily profiles, consideration of individual patientnd families illness, experiences and needs andmproved communication. (Caffin et al., 2007).
The role of the ICU liaison nurse includes prepa-ation for transfer, follow up visits of patients whoave been discharged from ICU and the provisionf practical, educational and emotional support foratients, their families and staff during the tran-ition phase from ICU to the wards (Caffin, 2005;haboyer et al., 2005b). The role of the ICU liaisonurse is not to threaten the position and responsi-ility of the ward staff, rather to collaborate withard staff to improve care for patients and their
amilies. It is well documented that patient acu-ty on the wards has increased significantly andhat ward staff may not have the knowledge andlinical skills to provide competent care for com-
lex patients who have recently been dischargedrom ICU (Chaboyer et al., 2005b). The ICU liaisonurse reduces transition anxiety by facilitating theransition from ICU to the wards for patients andheir families and acting as resource for families
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332
and ward staff (Green and Edmonds, 2004). In theircase study of 10 ward nurses’ from one hospi-tal and their perceptions of the ICU liaison nurseChaboyer et al. (2005b) found that the ICU liai-son nurse benefited the environmental preparationof the patient. This involved the liaison nursemeeting with the patient and family prior to dis-charge from ICU to the ward, informing them ofwhat to expect on the ward and informing staffof potential transfers and expected level of carerequirements. From an educational perspective theward nurses felt that they had gained skills andknowledge and were better prepared, to ease thetransition from ICU to the ward for the patient andfamily.
Discharge information
Leith (1998) reports that the provision of informa-tion through structured planning has the greatestpotential to prevent transfer anxiety in bothpatients and their family’s members. If family mem-bers are not provided with or fail to understandinformation they may respond or react in waysthat affect patient recovery including anger andhostility towards staff (Coyle, 2001; Mitchell andCourtney, 2005). This is certainly supported byanecdotal evidence from our practice within theliaison nurse role.
In Odell (2000)’s study, following discharge fromICU, most patients had forgotten or were con-fused about the verbal information that they hadbeen given prior to the transfer. She recommendsthe addition of supported written information thatpatients and relative can refer back to. Writteninformation provides tangible facts and supportsunderstanding and recall of information. Bouveet al. (1999) in their randomised controlled trialof 50 families whose children where being trans-ferred out of a paediatric ICU looked at the useof transfer preparation letters as well as verbalexplanation and found significantly lower anxietylevels for parents who received the written infor-mation. However, it was acknowledged in the paperthat the letter may have encouraged discussionprior to transfer, making it difficult to determinewhether the verbal or written information wasexclusively responsible for the reduction in anxietylevels.
Van Waning et al. (2005) developed a protocol fortransfers out of the ICU including the provision of
a transfer letter for families. They found the letterhelpful but they also identified the limitations ofthis for children whose family is illiterate or speaka different language. The development of bookletsexplaining the common experiences in relation toW
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S. Linton et al.
ischarge from ICU have been shown to be benefi-ial in helping patients and families understand andetain information (Coyle, 2001).
Mitchell and Courtney (2005) and Paul et al.2004) examined the design, development andntroduction of a written information booklet abouthe differences between ICU and the wards foratient’s and their families. Mitchell and Courtney2005) developed the brochure following input fromamily members, a panel of 10 expert critical careurses from multiple centres and senior personnelrom within their hospital. Following introductionf the brochure they found in their evaluation,ignificant improvements to all aspects of trans-er including greater family satisfaction and higherevels of understanding. Family members felt morenformed and significantly more prepared for trans-er. The evaluation also extended to nursing staffnd the findings supported the use of the brochures a useful framework to promote discussion withamilies. 95% of nurses recommended its introduc-ion for all future transfers (Mitchell and Courtney,005). In their collaborative study, Paul et al. (2004)nterviewed a small number of patients (7) andamilies (2) from within their hospital about theirnowledge of the transition from ICU to the wardsrior to designing the booklet. Despite receivingerbal information, they found wide variation inhe knowledge about transfer from ICU to theards. This supports the need for provision of con-
istent verbal information reinforced with writtenocuments. Following development and implemen-ation of the written booklet providing informationbout discharge from ICU to the wards, patientsere interviewed to evaluate its use. The major-
ty of responses were positive; however a numberf patients wanted more specific information aboutheir individual health status and ongoing manage-ent. Paul et al. (2004) acknowledge that written
ommunication does not replace verbal advice andupport.
Discussion of the advantages of the distributionf written information to families are all limitedo visually able, literate, English speaking popu-ations. As cultural and linguistic translations ofnformation are complex, direct translation areften not appropriate for people from non-Englishpeaking backgrounds (DHS, 2000). Therefore theame conclusions cannot be extrapolated to otheropulations who may have different cultural andommunication needs.
ritten information for families
here are major benefits for patients, families andtaff if levels of education, knowledge and under-
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tanding about health information are improvedKenny et al., 1998). Written information cane utilised to reinforce verbal discussions andave the advantage that they can be referred togain at other points in time. Written informationmproves communication between patient’s fam-lies and health care professionals (Paul et al.,004). Bouve et al. (1999) and Kenny et al. (1998)ound that the provision of written informationctually advances discussion between patients andtaff. The written information should not replaceerbal but can be utilised to enhance communica-ion, consistency and recall for patients and theiramilies.
There is a vast amount of written informa-ion available. For a brochure to be effective itust be noticed, understood, believed and remem-ered (Kenny et al., 1998). There is a tendencyo overcrowd brochures with information; this canave a negative effect on their efficacy (Mitchellnd Courtney, 2005). Although the most colour-ul brochure might appear to attract the greatestmount of attention, evidence suggests that therochure that is placed in the patient or family’sand by the nurse is the one that is noticed most,ead most and has the most benefit (Kenny et al.,998). It is important therefore that the ICU liaisonurse meet the family prior to discharge and explainheir role and process of discharge from ICU to theards in addition to providing the written brochure.tudies report that families prefer information toe individualised (Mitchell and Courtney, 2005), sohile brochures can provide generic information it
s important for the ICU liaison nurse to promoteiscussion and tailor the information for the par-icular experiences and needs of each patient andamily situation.
hase one—–parent questionnaire
ethods
efore constructing the written brochure for ourospital, it was important to identify the partic-lar areas in relation to the changes from ICU tohe wards that the families found to be a stress-ul experience. A brief one-page questionnaire waseveloped to identify the parent’s areas of stressnd their educational needs in relation to tran-
ition from ICU to the ward. The questionnairencluded stressors that were previously describedn the literature as the most common stressors foratients and families. Approval for the question-aire as an audit tool was gained from the RoyalwmpTf
brochure for families 333
hildren’s Hospital Human Ethics and Researchepartment.
All families of children discharged over a 2-eek-period were approached. Fifty questionnairesere distributed. Each questionnaire had 12 ques-
ions with a 5 point Likert scale (1 = not important,= slightly important, 3 = unsure, 4 = important= very important). Families were asked to con-
ider what was most stressful about their dischargerom ICU to the wards including changes in envi-onment, level of monitoring, number of medicaltaff or number of nursing staff. Families were alsosked about the importance of other aspects ofnformation including name and location of ward,hone number of ward, names of staff, presencef medical staff on the wards and patient—nurseatio.
esults
f the 50 questionnaires distributed, 35 wereeturned completed, giving a response rate of 70%.rom the 35 responses, children had spent fromto 28 days in the ICU. To identify the greatest
tressors in relation to discharge from ICU to theards median scores were calculated for each of
he questions asked. Results are listed in Table 1.The majority of parents identified the change in
nvironment between ICU and the wards was notarticularly stressful. Changes in the level of moni-oring and staffing including both medical and nurseo patient ratios all scored high in terms of level oftress.
Knowing the number of children in the roomn the ward was rated as only slightly importantnformation. Being informed about the nurse toatient ratio, the ward’s phone number, the namef the nurse and the name of the doctor caring forheir child were all rated the same level of impor-ance. The most important information accordingo the parents audited, was knowing the name andocation of the ward, being informed prior to andncluded in the plans for discharge from ICU to theards.
hase two—–development of theischarge brochure
he discharge from ICU to the wards brochure
as developed utilising the Victorian Govern-ent Department of Human Services guidelines onreparing well-written health information (2000).o ensure the brochure provided information in aamily friendly format using language that was clear
334 S. Linton et al.
Table 1 Results from parent questionnaire (n = 35)
Question Median
ResponseWhat would you consider stressful about your child’s discharge from ICU to the wards?
Changes in environment between ICU and the wards? 2Changes in level of monitoring between ICU and the wards 4Changes in the numbers of doctors for patients 4Changes in the number of nurses for patients 4
How important are the followingTo know the name and location of the ward before your child is
transferred?5
To know the ward’s phone number before your child istransferred?
4
To know the number of children each nurse has to care for inthe ward area before your child is transferred?
4
To know the name of the doctor caring for your child on theward?
4
To know the name of the nurse caring for your child on theward?
4
To know the number of children in your child’s room on theward?
2
To be included in the plans for discharge from ICU to the ward? 5To be informed prior to your child’s discharge from ICU to the
ward?5
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1 = not important, 2 = slightly important, 3 = unsure, 4 = importa
it was reviewed by the language experts in the‘kids health information’ department within thehospital. Bright colours and photographs were usedin addition to the written information. Refer toAppendix A to view the completed brochure.
The written content of the brochure was basedon the information gained from the results of theparent questionnaire. This enabled us to focusthe information based on the identified needsof the families. ‘The role of the ICU liaisonnurse’, ‘things that are different on the wards—–monitoring, staffing and environment’ and ‘keypoints to remember’ were used as headings tointroduce the information. Importantly there wasa space left at the back of the brochure for theLN to include on an individual basis which wardthe child would be going to and the relevant phonenumber. The addition of this individualised informa-tion provided an opportunity to promote discussionbetween the liaison nurses and families. At thistime we could ensure that the points identifiedas most important by families in our questionnaire(the name and location of the ward, being informedprior to and included in the plans for discharge
from ICU to the wards) were covered in detail.Any particular fears and/or questions that the par-ents had could also be raised and further planningaround transition arranged by the liaison nurse. Foretwcr
= very important.
xample, some families may benefit from a tourf the ward prior to transfer. Contact details werelso listed should parents wish to speak with eitherhe liaison nurse or ward nurse manager in theuture.
hase three—–evaluation of theischarge brochure
ethods
o evaluate the introduction of the brochure, theiaison nurse during their routine visits with fam-lies prior to discharge from the ICU to the wardver a 2-week-period, gave each family a brochure.ll families present prior to discharge were given arochure, even if they had previous experience ofward environment.A brief explanation about the brochure was given
o the families along with an evaluation form. Theiaison nurses explained that the brochure was aew initiative and the evaluation was important to
nsure the needs of families being discharged fromhe PICU were being met. Evaluation forms thatere completed were then given to the ICU nursearing for the patient prior to discharge and latereturned to the liaison nurses for collation.
Development and evaluation of a discharge information brochure for families 335
Table 2 Results From evaluation questionnaire (n = 21)
Question Scale
1 2 3 4 5Not at all Neutral Very much
(1) Was the brochure helpful in improvingyour understanding of what to expect onthe ward?
1 4 16
(2) Was it useful to have the wards nameand number written down prior to yourchild being transferred from PICU?
1 4 16
(3) Was the brochure easy to read andunderstand?
1 4 16
(4) Did the brochure help answer yourquestions regarding being transferred theward after PICU?
1 2 3 15
(5) Was it useful to have written literatureabout the transition phase from PICU to
1 1 6 13
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esults
f the 50 evaluations given out, only 21 wereeturned giving a response rate of 42%.
Results from these evaluation forms are sum-arised in Table 2.95% of the parents who responded believed the
rochure to be easy to read and understand alongith helpful or very helpful in improving theirnderstanding of what to expect on the ward. 95%lso found it useful to have the transfer wardsame and number written down prior to leaving theICU.
85% of respondents agreed that the brochureelped to answer their questions regarding beingransferred to the ward, while 5% found therochure not helpful at all with one parentommenting ‘before reading the brochure I wasomfortable for my child to go back to the wardhen we were told, but after reading the brochure
t pointed out a few things that made me start toorry’. 90% of parents found the brochure useful in
heir discharge preparation.
iscussion
n addition to the ICU liaison role, the introductionf a discharge brochure explaining the process of
ransfer to the ward from ICU for families receivedositive feedback. As discussed in the literature,tructured planning together with the provision ofoth verbal and written information has the great-st potential to prevent or at least reduce transferfrfi
nxiety in both patients and their family’s mem-ers.
Some parents found that reading the brochureaised more questions and issues they had not yethought of in regards to their ward transfer. Thiseinforces the need for the role of the LN to meetace to face with families prior to discharge toromote discussion in conjunction with the pro-ision of written information and include familiesn the plan for their child’s transfer from ICU tohe ward.
The questionnaire, brochure and evaluation pro-ess we used focused on the needs of the families.e did not specifically prepare written material for
he children in the discharge information process.his was because most of our patients were lesshan 2 years of age or did not have appropriate cog-itive function at discharge to understand writtenaterial. We do however recognise that including
nd communicating with children in the informa-ion delivery process is important, particularly forhe adolescent age group.
The literature around this topic of discharg-ng patients from ICU to the wards supports theole of the ICU liaison nurse and use of tailorediscussion and active preparation combined withritten information such as the brochure, to pre-are patients for what to expect over the transitioneriod.
The ICU liaison nurse should meet with each
amily prior to discharge and introduce theirole and the explain the process of dischargerom ICU to the ward in addition to provid-ng the written brochure, as while the brochure
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can provides families with generic informationregarding ICU transfer, it is important for theICU liaison nurse to promote discussion and tai-lor the information for the particular experiencesand needs of each patient and family situa-tion.
Limitations
With a response rate of only 42% it is diffi-cult to make significant conclusions. The liaisonnurse handed the questionnaires to families. Par-ents may have felt compelled to give positiveresponses to ensure ongoing involvement fromthe ICU liaison team. Parents who were not attheir child’s bedside, illiterate or from non-Englishspeaking countries were excluded, as translationand cultural adaptations of the questionnaire werenot possible in the available time frame. This isacknowledged as a major limitation of the audit.It is potentially this group of families that expe-rience the greatest levels of stress associatedwith transition as communication between hos-pital staff and family members is limited andtheir level of understanding will be compro-mised.
Conclusion
There is a significant quantity of information pub-lished that explores the issues associated withtransfer of patients from ICU to the wards. Althoughthe majority of articles are adult based many of theissues are relevant and possibly even magnified inthe paediatric population for the child and theirfamily. The introduction of the liaison nurse role isidentified within the literature as an interventiondesigned to improve communication with familiesand reduce the impact of transition anxiety. To aug-ment this role we have designed and introduceda brochure for families that includes informationabout the process of transfer from ICU to the wardand what to expect on the ward (Appendix A).From our evaluation we found that in conjunctionwith the ICU liaison nurse, the provision of writteninformation prior to transfer received positive feed-back. It remains important for the ICU liaison nurseto meet with each family prior to discharge andexplain their role and the process of discharge fromICU to the ward in addition to providing the written
brochure. While the brochure can provide familieswith generic information regarding ICU transfer, itis important for the ICU liaison nurse to promotediscussion and tailor information for the particularexperiences and needs of each patient and familyM
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S. Linton et al.
ituation. We recognise that this brochure is onlyractical for literate English speaking families andurther work needs to be done to address the issuesf communication in relation to discharge infor-ation for the children involved in the transitionrocess and importantly for non-English speakingamilies.
ppendix A. Supplementary data
upplementary data associated with this arti-le can be found, in the online version, atoi:10.1016/j.iccn.2008.06.002.
eferences
ouve L, Rozmus C, Giordano P. Preparing parents for their child’stransfer from PICU to the paediatric floor. Applied NursingResearch 1999;12(3):114—20.
affin C. Paediatric Intensive Care Liaison Nurse: Report on theOne Year Trial Position. Melbourne: Royal Children’s Hospital;2005.
affin C, Linton S, Pellegrini. Introduction of a liaison nurse rolein a tertiary paediatric ICU. Intensive and Critical Care Nurs-ing 2007.
haboyer W, James H, Kendall M. Transitional care afterthe intensive care unit: current trends and future direc-tions. Critical Care Nurse 2005a;25(3.) (16—18, 20—22, 24—26).
haboyer W, Gillespie B, Fosterm M, Kendall M. The impact of anICU liaison nurse: a case study of ward nurses’ perceptions.Journal of Clinical Nursing 2005b;14(6):766—75.
haboyer W. Intensive care and beyond: improving the tran-sitional experiences for critically ill patients and theirfamilies. Editorial. Intensive and Critical Care Nursing2006;22:187—93.
oyle M. Transfer anxiety: preparing to leave intensivecare. Intensive and Critical Care Nursing 2001;17(3):138—43.
epartment of Human Services, 2000. Communicating withConsumers, Good Practice Guide to Providing. Informa-tion. Victorian Government. http://www.health.vic.gov.au/consumer/pubs/communicate.htm.
epartment of Human Services, 2000. Communicating withConsumers Series, vol. 1, Well-Written Health Informa-tion: A Guide. Victorian Government. http://www.health.vic.gov.au/consumer/pubs/written.htm.
reen A, Edmonds L. Bridging the gap between the intensivecare unit and general wards—–the ICU liaison nurse. Intensiveand Critical Care Nursing 2004;20:133—43.
enny T, Wilson R, Purves I, Clark J, Newton L, Newton D, etal. A PIL for every ill? Patient information leaflets (PIL’s):a review of past, present and future use. Family Practice1998;15(5):471—9.
eith M. Transfer anxiety in critical care patients and their familymembers. Critical Care Nurse 1998;18(4):24—32.
cKinney A, Deeny P. Leaving the intensive care unit: a phe-nomenological study of the patient’s experience. Intensiveand Critical Care Nursing 2002;18(6):320—31.
cKinney A, Melby V. Relocation stress in critical care. Journalof Clinical Nursing 2002;11:149—57.
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M
O
P
V
evelopment and evaluation of a discharge informa
itchell M, Courtney M. Improving transfer from the intensivecare unit: the development, implementation and evaluationof a brochure based on Knowles’ Adult Learning Theory. Inter-national Journal of Nursing Practice 2005;11(6):257—68.
dell M. The patient’s thoughts and feelings about their transferfrom intensive care to the general ward. Journal of AdvancedNursing 2000;31(2):322—9.
aul F, Hendry C, Cabrelli L. Meeting patient and relative’s needsupon transfer from an intensive care unit: the development
W
Available online at www.s
brochure for families 337
and evaluation of an information booklet. Journal of ClinicalNursing 2004;13(3):396—405.
an Waning N, Klieber C, Freyenberger B. Development andimplementation of a protocol for transfers out of the pae-
diatric intensive care unit. Critical Care Nurse 2005;23(3):50—5.hittaker J, Ball C. Discharge from intensive care: a viewfrom the ward. Intensive and Critical Care Nursing 2000;16:135—43.
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