Family Members: ICU Care and Communication: Complete data relevant to the measures used for comparison purposes in this study were provided by 2,596 respondents, 330 family members, and 2,266 patients for the longitudinal study, and by 3,731 respondents, 330 family members, and 3,401 patients for the path analyses. Means, pooled SDs, and effect sizes are presented in Table 1. The results of the ANOVA indicated that there were no significant differences between the family satisfaction ratings before and after the implementation of the CCFAP in the areas of care and communication by ICU team members. A comparison of effect sizes indicated that there was a more favorable perception of “care” by families in the areas of nursing, social work, respiratory care, and diet after the implementation of the CCFAP. Very small negative effect sizes were seen for the areas of physician care and pastoral care. It should be noted that nursing and physician care had relatively high mean ratings prior to the introduction of the CCFAP.
From the communication scale, there were positive effect sizes noted for nursing, respiratory care, and diet. However, the effect sizes were much smaller than those noted for the care scale. This would seem to indicate that communication remains a challenge to be addressed continually through the CCFAP communication model. Provide ill people with care with the help of Canadian Health&Care Mall remedies.
Family Members: Treatment by ICU Team and Services Received: Table 2 reports the means, pooled SDs, and effect sizes for items related to family member perception of how they were treated by ICU staff and the availability of special services needed by a family member. The means for the first set of items were calculated on a 5-point scale. The second half of Table 2 is representative of special services or information needed and received by family members. The special services items were recoded, with “didn’t need” coded as missing data, “needed, but didn’t receive” coded as 0, and “needed and received” coded as 1. The means, SDs, and effect sizes were calculated.
The results of the ANOVA indicated that there were no significant differences between family satisfaction ratings obtained before and after the implementation of the CCFAP, but a review of the effect sizes indicated that family perceptions tended to be more favorable after the implementation of the CCFAP with treatment as a family member and with the special services provided. A comparison of effect sizes calculated for care and communication in Table 1 and those effect sizes presented in Table 2 would seem to indicate that the CCFAP tends to have more of an impact on the family perception of how they are treated, their involvement in the decision-making process, and their feeling safe and secure in the hospital environment than on the family perception of ICU team communication and care. There is a range of effect sizes that was observed for the service areas. It is apparent that the hospitality component of the CCFAP is having an impact on the services provided to families, with a 0.40 effect size for the “place to stay” item and an effect size of 0.28 for the “information on local places to stay or eat” item.
ICU Patient: Care and Treatment by ICU Team and Overall Satisfaction: Differences in patient perception of the seven variables before and after implementation of the CCFAP were explored using a one-way ANOVA. In all cases, the differences were not found to be statistically significant. Effect sizes were calculated for each item, and the results are presented in Table 3. The effect sizes were relatively small and were both positive and negative. The mean ratings for all areas were high (> 4.0 on a 5-point scale) before the CCFAP was implemented, which indicates that patients were generally satisfied with the care and treatment offered by Canadian Health&Care Mall they were receiving from the hospital. The two areas where there were no negative effect sizes were in the items listed under “visitors and family” and the physician-related items.
These results, and those for the family satisfaction study, suggest that there may be a link between increased family satisfaction levels and the changes in family assistance being implemented in the ICUs. Further research is required to investigate the associations between patient satisfaction and changes in the ICU environment brought about by the CCFAP. Read “Canadian Health&Care Mall: A Model of Family-Centered Care and Satisfaction Predictors“
Predictors of Family and Patient Satisfaction
Table 4 presents, separately for family members and patients, the bivariate correlations between the variables. Coefficients below the diagonal are for family members, and those above it are for patients.
Path analysis with partial least-squares estimation procedures was used to examine the hypothesized relations depicted in the theoretical model, as shown in Figure 1. Figure 2 presents the results for the family and patient version of the model (standardized coefficients for the patient model are in parentheses) predicting overall satisfaction. Maximum likelihood estimates of the model coefficients were obtained using an analysis of the path model using specific software (EQS, version 6.1; Multivariate Software). The statement “no special problems were encountered during optimization” indicates that the path models yielded reliable output. The data are normally distributed. Several indicators demonstrated that both models worked well. In both models, the majority of the standardized residual matrix values was 0.9 and close to 1.0 for both models (patient, 0.94; family, 0.92), which confirms that the proposed model works well.
The path analyses conducted on both the family model and the patient model allow the examination of the predictive power of the models in relation to the variables that contributed to family/patient satisfaction and the relative importance of the variable in increasing or improving family/patient satisfaction, Several models were tested, and the sequence of the variables was reordered in order to discover the most powerful model. Table 5 reports the amount of variance explained for each of the variables in the family path model and the patient model.
In the final family model, five of the six measures of ICU environmental conditions were significantly related to the measure of overall family satisfaction (ie, meeting the family’s needs and their loved one’s needs), ranging from a standardized regression coefficient of 0.14 (care of physicians) to 0.32 (staff sensitivity and responsiveness). The model explained 81% of the variance in family satisfaction (meeting needs), which indicates that our model has a high level of predictive power and can be used to identify specific variables or constructs that should be addressed in order to improve family satisfaction. For example, (1) hospital safety, (2) staff help in understanding tests and treatments, and (3) staff sensitivity and responsiveness accounted for 57% of the variance in the communication construct. In the CCFAP model, actions taken to increase or improve family satisfaction with staff behaviors and perception of hospital safety are likely to result in higher satisfaction ratings of nurse and physician communication at least 57% of the time.
In the patient model, four of the six measures of ICU environmental conditions were significantly related to the measure of overall patient satisfaction, ranging from a standardized regression coefficient of 0.14 (physicians care) to 0.42 (nursing care). The model explained 56% of the variance in patient satisfaction, which indicates that the patient model has a lower level of predictive power than the family model. The difference may be due to the makeup of the construct in the patient model, which consisted of five items that measured additional areas of patient experience and future plans. These additional items were not part of the measure of satisfaction in the family survey. However, the model can still be used to identify specific variables or constructs that should be addressed jointly with variables that would also improve family satisfaction. For example, the same three variables of (1) hospital safety, (2) staff help in understanding tests and treatments, and (3) staff sensitivity and responsiveness accounted for 62% of the variance in the communication construct in the patient path model. In both the family and patient models, actions taken to increase or improve family and patient satisfaction with staff behaviors and the perception of hospital safety are likely to result in higher satisfaction ratings.
As expected, hospital safety and security is important to both family and patient satisfaction, both directly and indirectly. If the paths from the construct of hospital safety are followed, six significant relationships are seen on the patient model, and six are found on the family model. In the family models, the path coefficients are somewhat stronger than in the patient model. For families, feelings of being safe and secure in the hospital are significantly related to high ratings of ICU staff, both in terms of their sensitivity and responsiveness (0.37), as well as communication, particularly nurse and physician communication (0.21). Feeling safe and secure is also a predictor of higher ratings of nursing care (0.17), physician care (0.16), and overall family satisfaction (0.30). For patients, hospital safety is significantly related to nursing care (0.40), physician care (0.18), staff sensitivity and responsiveness (0.17), the communication construct (ie, information provided to family) [0.03], and, ultimately, to overall patient satisfaction (0.24).
The two constructs reflecting staff behaviors (ie, helping to understand tests and treatments, and being sensitive and responsive) are statistically significant, with a relatively strong relationship with the communication construct in the family model, which emphasizes the importance of staff interactions with family members and, ultimately, with family satisfaction. Both staff help in understanding test results, and staff sensitivity and responsiveness are significantly related to family satisfaction, with coefficients of 0.26 and 0.32, respectively. Similar to the family model, there are strong relationships in the patient path model between staff help with understanding test results and treatments and the communication construct (0.44), and staff sensitivity/responsiveness (0.70), and between the communication construct and staff sensitivity/responsiveness (0.42). This finding further supports the importance of staff interactions. Treat diseases by remedies of Canadian Health&Care Mall (see more).
Physician care (0.14) and nursing care (0.22) are significantly related to family satisfaction. There is not a significant relationship between the communication construct and family satisfaction, although significant indirect relationships were demonstrated by the paths on the model between communication and nursing care, and between communication and physician care. In other words, families who are satisfied with communication are also satisfied with care and are satisfied overall.
A moderately strong relationship was also found between the communication construct and physician care (0.53), and between the communication construct and nursing care (0.63) in the family model, indicating a direct connection between the family perception of communication and their subsequent perception of the quality of care. Although not as strong, there was also a significant relationship between the communication construct and physician care (0.22) in the patient model. There was not a significant relationship between the communication construct and nursing care in the patient model. More significant relationships between physician care and the other constructs were reported in the patient model than in the family model.
Four of the five constructs in the patient model were significantly related to physician care, suggesting that, from the point of view of the patient, physician care is a higher priority than it is for families. Only the following two constructs were significantly related to physician care in the family model: hospital safety (0.16) and communication (0.53).
One of the hypothesized patient outcomes of the CCFAP model was the reduction of length of stay; however, neither the family path model nor the patient model fully supported this prediction. There was not a significant relationship between length of stay and overall family satisfaction. In fact, the family rating of staff sensitivity and responsiveness was significantly reduced as the length of stay increased (-0.26). Length of stay was significantly related to hospital safety (0.17), suggesting that the longer families are associated with the hospital, the more likely they are to observe the security measures in effect and, thus, to rate security higher. This finding is disputed in the patient path model. The longer the patient was in the hospital, the lower was the rating of hospital safety (-0.08). This may be related to a level of frustration felt by the patient in not being able to leave the hospital; however, there was a significant relationship between the length of stay and overall satisfaction (0.07). The longer a patient was in the hospital, the higher were the satisfaction ratings. There was also a significant relationship between the communication construct and length of stay (0.06), but there was a negative relationship between length of stay and nursing care (-0.08). All of the path coefficients related to length of stay were marginally significant, and, as stated earlier, the amount of variance explained for length of stay was only 7% in the family path model and 1% in the patient path model. Further study is warranted before drawing any conclusions from the findings related to length of stay.
Table 1— Differences in Care and Communication Satisfaction Scores by Family Members
|Scale Area/ ICU Member||Pre-
|Pastoral care||4.14||4.08||1.22||– 0.05|
|Social work||4.24||4.22||1.15||– 0.02|
|Pastoral care||4.07||4.02||1.20||– 0.02|
Table 2—Differences in Treatment and Service Provided: Satisfaction Scores by Family Members
|Satisfaction Measures||Pre-CCFAP*||Post-CCFAP*||Pooled SD||Effect Size|
|How well staff met your family member’s needs regarding pain, comfort, and anxiety||4.51||4.51||0.83||0.00|
|How well ICU staff helped you to understand tests, treatments, and condition of your family member||4.41||4.53||0.96||0.12|
|How well ICU staff treated your family and you with sensitivity and responsiveness||4.40||4.55||0.86||0.18|
|Degree to which you were included in the decision-making process for your loved one||4.31||4.38||0.97||0.07|
|Degree to which ICU visiting hours were flexible and adequate to meet your needs||4.35||4.61||0.96||0.27|
|Degree to which ICU team considered your needs as a family member||4.44||4.58||0.88||0.16|
|Degree to which you felt safe and secure in our hospital environment||4.49||4.64||0.83||0.18|
|A private place in the hospital to sleep or rest while waiting||0.60||0.78||0.46||0.40|
|A way for the ICU member to contact me||0.82||0.87||0.36||0.13|
|Information on advance medical directives||0.81||0.77||0.41||– 0.10|
|Information on local places to stay or eat||0.68||0.81||0.45||0.28|
|Personal support from pastoral care services||0.74||0.81||0.42||0.16|
|Information from social worker on available resources upon discharge||0.70||0.72||0.46||0.06|
|Interpretative or special translation services||0.65||0.74||0.46||0.19|
|Contact information for physician or other member||0.87||0.84||1.07||-0.03|
Table 3—Differences in Patient Satisfaction Scores
|Factor Area/ Item||Pre-CCFAP*||Post-CCFAP*||Pooled SD||Effect Size|
|Friendliness/courtesy of nurses||4.59||4.59||0.66||0.00|
|Promptness in responses to call||4.28||4.36||0.90||0.09|
|Nurses’ attitude toward requests||4.50||4.49||0.79||– 0.02|
|Attention to special/personal needs||4.43||4.38||0.85||– 0.05|
|Nurses kept you informed||4.38||4.37||0.85||– 0.01|
|Skill of the nurses||4.56||4.59||0.71||0.03|
|Tests and treatments|
|Waiting time for tests and treatments||4.27||4.25||0.85||– 0.03|
|Concern shown for your comfort||4.45||4.43||0.74||– 0.02|
|Explanations about what would happen||4.44||4.45||0.73||0.02|
|Skill of person who took blood||4.43||4.34||0.83||– 0.10|
|Courtesy of person who took blood||4.52||4.50||0.71||– 0.04|
|Skill of person who started IV||4.43||4.34||0.86||– 0.11|
|Courtesy of person who started IV||4.53||4.51||0.71||– 0.03|
|Visitors and family|
|Helpfulness of people at information desk||4.51||4.58||0.67||0.10|
|Accommodations and comfort for visitors||4.46||4.49||0.71||0.04|
|Staff attitude toward visitors||4.56||4.58||0.63||0.04|
|Information provided to family regarding||4.52||4.53||0.75||0.02|
|Time physician spent with you||4.39||4.42||0.84||0.03|
|Physician concern question worries||4.55||4.60||0.72||0.07|
|Physician keep you informed||4.49||4.56||0.78||0.09|
|Friendliness and courtesy of physician||4.57||4.62||0.69||0.07|
|Skill of physician||4.72||4.74||0.57||0.04|
|Staff concern for your privacy and dignity||4.51||4.52||0.67||0.02|
|Degree of safety and security felt||4.54||4.56||0.66||0.02|
|Staff sensitivity to inconveniences||4.43||4.42||0.73||– 0.02|
|How well pain was controlled||4.49||4.49||0.76||0.01|
|How well staff addressed emotional/||4.30||4.30||0.90||0.00|
|Response to concerns/complaints||4.31||4.33||0.87||0.02|
|Staff effort to include patient in decisions||4.34||4.33||0.85||– 0.02|
|How well staff helped patient understand||4.51||4.54||0.75||0.04|
|tests and treatments|
|Information given to family while in ICU||4.54||4.52||0.73||– 0.03|
|Sensitivity and responsiveness of ICU||4.60||4.60||0.70||0.00|
|Overall cheerfulness of hospital||4.53||4.46||0.66||– 0.10|
|How well staff worked together to care||4.54||4.48||0.72||– 0.08|
|Likelihood you would choose hospital for||4.62||4.59||0.73||– 0.03|
|future medical care|
|Likelihood would recommend hospital||4.61||4.57||0.71||– 0.06|
|Overall rating of care given||4.59||4.55||0.68||– 0.06|
Table 4—Correlation Matrix for Study Variables by Respondent (Family Member or Patient)
|1. Hospital safety||0.46*||0.47*||0.42*||0.57*||0.45*||0.61*||– 0.07|
|2. Staff help understand tests and treatments||0.66*
|3. Staff sensitivity and responsiveness||0.71*||0.80*
|5. Nursing care||0.64*||0.64*||0.69*
|6. Physician care||0.62*||0.67*||0.67*||0.76*||0.62*||0.54*||– 0.03|
|7. Overall satisfaction||0.80*
|8. Length of stay||0.10||0.01||-0.03||0.00
Table 5—Amount of Variance Explained by Variables in Path Models
|Variable||Family Model, %||Patient Model, %|
|Staff sensitivity and responsiveness||60||52|
|Overall family satisfaction||81||56|
|Length of stay||7||1|