Kifell J, Slobod D, Lewis KB, Goldfarb M. Direct Observation of Family Engagement Practice in a Cardiovascular Intensive Care Unit. J Patient Exp. 2025 Mar 28;12:23743735251330463.
WELCOME TO THE NURSING PRACTICE JOURNAL CLUB . Please select FOUR articles and answer TWO questions each for journal club participation credit. CUT AND PASTE ANSWERS FROM TEXT OF ARTICLE WILL NO LONGER BE ACCEPTED. When completed, I or your unit manager can sign you off. For completion certificate from me or any questions, please contact me at cindy.swenson@providence.org . Thank you Cindy Swenson RN 3North DISCUSSION QUESTIONS(select two for each journal selection) 1)How does this research article compare to our practice, policy and/or procedure? 2) What are the advantages and disadvantages to the proposed recommendations in the article? 3) What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital? 4 Describe the method used by the author in the study 5) Was the correct method used? why or why not? 6)Discuss the sample size used in the study 7) Discuss the limitations of the article: limited sample size,...
1) What are the advantages and disadvantages of implementing the the article recommendations on your unit and/or hospital?
ReplyDeleteThe article mentions that family involvement in the intensive care has been shown to improve care quality and lead to improved patient and family centered outcomes. Most interesting fact reported was that patients with family present were three times less likely to be readmitted to the hospital within a 30 day period. Knowing these facts could lead to an increased emphasis on encouraging family presence at the patient bedside during their hospital stay and closer observation of the types of family intervention as delineated in the article.
2) Discuss the limitations of the article:
There were several limitations listed: Detailed family member demographics data was not collected. Observations were only conducted on weekdays during daytime hours. Families were not able to be observed behind closed curtains. Family behaviors observed were rounded to 15min intervals leading to potential overestimations of family engagement time.
1) What are the advantages and disadvantages of implementing the the article recommendations on your unit and/or hospital?
DeleteImplementing the recommendations from Kifell et al. (2025) on direct observation of family engagement in a cardiovascular intensive care unit could bring several advantages and challenges to your unit or hospital. On the positive side, adopting family engagement practices has the potential to improve patient outcomes by reducing stress and enhancing adherence to treatment plans. Families who feel involved often report greater satisfaction and trust, which also supports organizational goals related to patient-centered care and accreditation standards. Furthermore, direct observation of family engagement can help staff identify barriers and gaps in practice, leading to targeted improvements in policies and training. However, there are also disadvantages to consider. Increasing family involvement may disrupt workflow in a busy unit, and some staff members may resist changes due to discomfort or concerns about efficiency. Issues of privacy and confidentiality can also arise, particularly in sensitive cases. In addition, implementing these changes may require additional resources, such as staff training or policy adjustments, and not all families may be equally willing or able to participate. Overall, while the recommendations could strengthen a culture of family-centered care and improve both patient and family experiences, careful planning, staff support, and clear guidelines would be necessary to address the potential challenges.
2. Discuss the limitation of the article:
The study by Kifell, Slobod, Lewis, and Goldfarb (2025) on direct observation of family engagement practice in a cardiovascular intensive care unit provides valuable insight into how family-centered care is operationalized in critical care. However, several limitations should be acknowledged. First, the study appears to be conducted within a single unit, which may limit the generalizability of its findings to other hospitals, specialties, or patient populations. The observational design, while useful for capturing real-world practices, may also introduce observer bias, as staff behavior can be altered when they know they are being observed. Additionally, the study may not fully capture the perspectives of families themselves, as the emphasis is on observed engagement rather than in-depth qualitative exploration of family or patient experiences. Another limitation is the potential lack of longitudinal data, which makes it difficult to assess the long-term effects of family engagement practices on outcomes such as recovery, readmission, or satisfaction. Finally, contextual factors—such as staffing levels, organizational culture, or policies regarding family presence—could influence the findings, but may not have been fully accounted for in the study.
1. Describe the method used by the author in the study.
ReplyDeleteA prospective observational study was conducted in a cardiovascular intensive care unit (CVICU) at the Jewish General Hospital in Montreal, Canada. The study was part of a quality improvement initiative and later received ethics approval for retrospective patient data collection.
Setting:
The CVICU has 16 beds, an open visitation policy, and serves a diverse urban population. Family members are routinely informed about how they can support patient care.
Participants:
104 patients were observed between October and December 2022.
A “family member” was defined as anyone present in the room and involved in care.
Patients admitted for less than 12 hours were excluded.
2. Discuss the sample size used in the study.
The sample size of 104 patients provided valuable insights into family engagement behaviors in the CVICU. Still, the lack of formal sample size calculation and the single-site design means the results should be interpreted cautiously and validated in larger, multi-center studies.
1. Advantages and Disadvantages of the Findings/Recommendations
ReplyDeleteThis study shows several advantages of encouraging family engagement in the cardiovascular ICU. Families were often involved through communication, active presence during rounds, and direct contributions to care such as feeding or helping with hygiene, which provided patients with emotional and physical support. The findings also suggest that family presence may lower 30-day hospital readmissions, which can improve outcomes and reduce healthcare costs. In addition, family engagement supports patient- and family-centered care, making patients feel more supported and families more informed. However, there are also disadvantages and challenges. The study found that patients with family present were more likely to die in the hospital, though this may reflect families being more present when patients are critically ill or in palliative care. Another limitation is that engagement practices may vary widely across cultural, social, and institutional settings, so the results cannot be generalized to all ICUs. Finally, since this was an observational study, no direct cause-and-effect relationship can be confirmed.
2. Method Used by the Authors
The authors used a prospective naturalistic observational study design in a cardiovascular ICU at an academic hospital in Montreal, Canada. Over a three-month period, 104 patients were observed during 151 sessions that took place on weekdays in the morning, afternoon, and evening. Every 15 minutes, study personnel walked through the unit and recorded whether family was present, how many family members were there, and what types of engagement behaviors occurred. Engagement was classified into categories such as communication, active presence, direct contribution to care, decision making, and family needs, with overlapping activities recorded in multiple categories when appropriate. Patient outcomes, such as hospital readmission, mortality, and length of stay, were collected from electronic health records and compared between patients with and without family present. Statistical tests, including chi-squared, Fisher’s exact, and t-tests, were used to analyze differences. This approach allowed the researchers to describe real family engagement behaviors in detail while also exploring links to measurable patient outcomes.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDelete- The article's recommendations to increase family engagement in the CVICU offer clear benefits, including improved patient outcomes, reduced readmissions, better caregiver preparedness, and more patient-centered care. Families feel more informed and supported, while patients gain emotional comfort and advocacy. These strategies also pose challenges, such as added demands on staff, slower workflows, potential role confusion, emotional strain for families, equity barriers, and infection control concerns. Overall, the advantages are significant but require careful implementation to minimize drawbacks.
2. Describe the method used by the author in the study.
- The author used a prospective naturalistic observational study where families of CVICU patients were observed during hospitalization to examine how engagement impacted outcomes. Data was then analyzed to identify associations between family involvement, readmissions, and other patient or caregiver experiences. This method allowed the researchers to capture real-world family engagement and its effects on patient outcomes without altering the natural care environment.
Q1: How does this research article compare to our practice, policy, and/or procedure?
ReplyDeleteThis article shows that when family members are present and engaged—through communication, active presence, or direct contribution to care—patients in the CVICU had better outcomes, including a lower chance of being readmitted within 30 days. In our unit, family presence is encouraged, but it’s often informal and depends on the nurse or situation. We don’t always have structured ways to involve families in communication or care. Compared to the study, our practice could benefit from creating more consistent opportunities for family engagement, instead of it being situational.
Q2: Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The authors acknowledge several limitations. The study was conducted in a single cardiovascular ICU with 104 patients, so the findings may not apply to other ICUs or patient populations. It was also observational, so while they found that family presence was linked to fewer readmissions, they can’t prove it was the direct cause. The researchers also mention that the way family engagement was observed might not capture all the details or quality of those interactions. These factors limit how broadly we can apply the results, but the study still provides a useful starting point.
Question 1) What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteAs outlined in the article, some advantages of the proposed recommendation of utilizing engagement of family members in the care of cardiovascular ICU patients include; better patient outcomes, better communication, reduced anxiety of the patient and family, and even equity in care. Family members act as a patient advocate and are able to be ethical decision makers and communicate the proper needs of the patient. Disadvantages are few when the communication is smooth and leading to the previous advantages listed but when barriers aren't met, family involvement can lead to further stress of the patient and family. It can also lead to privacy and consent issues when the proper policies are not being followed.
Question 2)Discuss the sample size used in the study
The sample size used in the study came out to 104 cardiovascular ICU patients being observed. Of the patients, 61 patients had families that were present and involved in care, and 43 patients had no family present. The sample size provided ample data to study and analyze. The sample sized was observed by the researchers using direct observation and because of that, adequate data was able to be extracted.
1. Describe the method used by the author in the study.
ReplyDeleteThe study employed a prospective, naturalistic observational design within a 16-bed cardiovascular intensive care unit (CVICU) at the Jewish General Hospital. Observations were systematically conducted on weekday mornings, afternoons, and evenings in 2- to 4-hour blocks, during which researchers documented family presence, the number of family members, and specific engagement behaviors at 15-minute intervals. Family engagement was classified across five domains—family presence, communication, decision-making, direct care, and family needs—using a structured checklist that permitted the simultaneous recording of multiple behaviors. Patient demographic and clinical information was extracted from electronic health records, and comparative statistical analyses were conducted to examine differences in outcomes between patients with and without family presence.
2. Discuss the sample size used in the study.
The study encompassed observations of 104 patients admitted to the CVICU from October to December 2022. Among these, the majority had family members present during at least one observation period. A total of 151 observation sessions were conducted, with certain patients being observed multiple times, ranging from two to six sessions per individual. Given the naturalistic observational design of the study, a formal sample size calculation was not deemed necessary, as the primary objective was to capture real-world patterns of family engagement.