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Hatakeyama J, Nakamura K, Sumita H, Kawakami D, Nakanishi N, Kashiwagi S, Liu K, Kondo Y. Intensive care unit follow-up clinic activities: a scoping review. J Anesth 2024:10.1007/s00540-024-03326-4. [PMID: 38652320 DOI: 10.1007/s00540-024-03326-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/12/2024] [Indexed: 04/25/2024]
Abstract
The importance of ongoing post-discharge follow-up to prevent functional impairment in patients discharged from intensive care units (ICUs) is being increasingly recognized. Therefore, we conducted a scoping review, which included existing ICU follow-up clinic methodologies using the CENTRAL, MEDLINE, and CINAHL databases from their inception to December 2022. Data were examined for country or region, outpatient name, location, opening days, lead profession, eligible patients, timing of the follow-up, and assessment tools. Twelve studies were included in our review. The results obtained revealed that the methods employed by ICU follow-up clinics varied among countries and regions. The names of outpatient follow-up clinics also varied; however, all were located within the facility. These clinics were mainly physician or nurse led; however, pharmacists, physical therapists, neuropsychologists, and social workers were also involved. Some clinics were limited to critically ill patients with sepsis or those requiring ventilation. Ten studies reported the first outpatient visit 1-3 months after discharge. All studies assessed physical function, cognitive function, mental health, and the health-related quality of life. This scoping review revealed that an optimal operating format for ICU follow-up clinics needs to be established according to the categories of critically ill patients.
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Affiliation(s)
- Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Hidenori Sumita
- Clinic Sumita, 305-12, Minamiyamashinden, Ina-cho, Toyokawa, Aichi, 441-0105, Japan
| | - Daisuke Kawakami
- Department of Intensive Care Medicine, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Shizuka Kashiwagi
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road CHERMSIDE QLD 4032, Brisbane, Australia
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Lobato CT, Camões J, Carvalho D, Vales C, Dias CC, Gomes E, Araújo R. Risk factors associated with post-intensive care syndrome in family members (PICS-F): A prospective observational study. J Intensive Care Soc 2023; 24:247-257. [PMID: 37744068 PMCID: PMC10515326 DOI: 10.1177/17511437221108904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background The family members of intensive care unit (ICU) patients play a crucial role in modern ICUs. These individuals are predisposed to the development of post-intensive care syndrome in family members (PICS-F), a syndrome experienced by family members of ICU patients in response to critical illness and characterised by new or worsening psychological symptoms. This study sought to evaluate the levels of anxiety and depression exhibited by the family members of patients hospitalised in the ICU. It also aimed to identify the risk factors associated with the experience of PICS-F, which should assist with its prevention in the future. Methods The study sample comprised 164 ICU patients and their family members. Sociodemographic data were gathered at the time of ICU admission and 3 months after discharge, and the family members were screened for emotional distress using the Hospital Anxiety and Depression Scale (HADS). Comparison tests were used to test for an association between family/patient characteristics and a positive HADS score. In addition, a multivariable logistic regression model was constructed to identify the independent factors associated with a positive HADS score. Results Emotional distress was identified in 24% of the family members 3 months after their relatives had been discharged from the ICU. A number of personal traits were found to be associated with emotional distress in the family members, namely unemployment (p = .008), smoking/drinking habits (p = .036) and personal history of psychopathology (p = .045). In the multiple logistic regression analyses, only unemployment was found to be an independent factor associated with both anxiety and depression in the family members (OR = 2.74, CI 95%: 1.09-6.93). No association was found between the patients' characteristics and emotional distress in the family members. Conclusions The findings of this study indicate an association between emotional distress in the family members of ICU patients and their personal traits, thereby building on the prior literature by suggesting that patient characteristics are less pertinent to the experience of PICS-F. Unemployment may represent a meaningful risk factor for emotional distress in family members (a potential marker of PICS-F), given its relationship with family members' positive HADS scores post-ICU discharge. These findings should influence preventative strategies concerning PICS-F by illustrating the need to assess family characteristics and demographics early in a patient's ICU stay and, consequently, allowing for the early identification of at-risk individuals and the prompt implementation of adequate support services.
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Affiliation(s)
- Carolina Tintim Lobato
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - João Camões
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - Daniela Carvalho
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - Cláudia Vales
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - Cláudia Camila Dias
- Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- RISE- Health Research Network- From the Lab to the Community, Porto, Portugal
| | - Ernestina Gomes
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - Rui Araújo
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
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Laflamme SZ, Bouchard K, Sztajerowska K, Lalande K, Greenman PS, Tulloch H. Attachment insecurities, caregiver burden, and psychological distress among partners of patients with heart disease. PLoS One 2022; 17:e0269366. [PMID: 36121800 PMCID: PMC9484654 DOI: 10.1371/journal.pone.0269366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Caregiver psychological distress (i.e., depression and anxiety) is harmful to both caregiver and patient. Different affect-regulation strategies associated with attachment orientations may impact a caregiver’s perception of their caregiving role as a burden, thereby contributing to their psychological distress. The aim of the present investigation was to examine the links among attachment orientations, caregiver burden, and psychological distress in a cardiac context. Participants (N = 181, Mage = 61.79, SD = 10.49; males = 24.7%) were romantic partners of patients with heart disease (i.e., informal caregivers) who completed validated questionnaires. The majority of caregivers had partners with coronary artery disease (n = 127, 70. 2%). 66.3% of caregivers reported low burden, 87.6% reported low levels of depression and 89.9% reported low levels of anxiety. The mean anxious attachment score was 2.74 (SD = 1.37) and the mean avoidant attachment score was 2.95 (SD = 1.26). Four mediation analyses were run using PROCESS macro for IBM SPSS (version 26). Statistical models showed that the relationships between attachment anxiety and psychological distress were mediated by caregiver burden [abanxiety= 0.15, 95% C.I. (0.04, 0.29); abdepression = 0.15, 95% C.I. (0.05, 0.28)] and that attachment avoidance was not a significant covariate (cvanxiety = −0.02, p>0.05; cvdepression = 0.40, p>0.05). The relationships between attachment avoidance and psychological distress were also mediated by caregiver burden [abanxiety = 0.23, 95% C.I. (0.10, 0.42); abdepression = 0.21, 95% C.I. (0.09, 0.37]with attachment anxiety as a significant covariate (cvanxiety = 1.09, p<0.001; cvdepression = 1.09, p<0.001). Interventions for caregivers reporting attachment insecurity and burden should be explored to potentially lessen caregiver distress as they support their partners with heart disease.
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Affiliation(s)
- Simone Zofia Laflamme
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karolina Sztajerowska
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Lalande
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Paul S. Greenman
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients. Crit Care Explor 2022; 4:e0753. [PMID: 36050994 PMCID: PMC9426807 DOI: 10.1097/cce.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the degree to which an ICU patient’s family member having an “anxious” psychologic attachment orientation is a risk factor for developing long-term posttraumatic stress disorder (PTSD) symptoms following patient ICU discharge or death.
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Left alone outside: A prospective observational cohort study on mental health outcomes among relatives of COVID-19 hospitalized patients. Psychiatry Res 2022; 307:114328. [PMID: 34906830 PMCID: PMC8647392 DOI: 10.1016/j.psychres.2021.114328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/25/2021] [Accepted: 12/04/2021] [Indexed: 02/01/2023]
Abstract
Hospitalization due to COVID-19 bears many psychological challenges. While focusing on infected patients, their relatives are being largely neglected. Here, we investigated the mental health implications of hospitalization among relatives, over a one-month course. A single center study was conducted to assess relatives of COVID-19 patients during the first month from their admission to the hospital, and elucidate risk and protective factors for mental health deterioration. Ninety-one relatives of the first patients to be hospitalized in Israel were contacted by phone and screened for anxiety, depression, and posttraumatic stress symptoms (PTSS) at three time points (25-72 hours, 7-18 days, and one month). We found that anxiety and depression decreased significantly during the first month from their admission. Risk factors for deteriorated mental health at one month included feelings of mental exhaustion, financial concerns, and social disconnection. Being an ultra-orthodox was a protective factor for anxiety and depression but not for PTSS. Our findings emphasize the importance of addressing the mental health status of close relatives and adjust support for the unique setting of COVID-19.
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González-Martín S, Becerro-de-Bengoa-Vallejo R, Rodríguez-García M, Losa-Iglesias ME, Mazoteras-Pardo V, Palomo-López P, Rodríguez-Sanz D, Calvo-Lobo C, López-López D. Influence on Depression, Anxiety, and Satisfaction of the Relatives' Visit to Intensive Care Units prior to Hospital Admission for Elective Cardiac Surgery: A Randomized Clinical Trial. Int J Clin Pract 2022; 2022:1746782. [PMID: 35685601 PMCID: PMC9159139 DOI: 10.1155/2022/1746782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/16/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intensive care units (ICUs) may produce stress on the relatives of patients that have long-term physiological and psychological implications. OBJECTIVES This study aimed to evaluate the effects of the relatives´ visit prior to hospital admission(s) on the patient's scheduled cardiac surgery regarding depression, anxiety, and satisfaction of the patient's family in an ICU. METHODS A randomized clinical trial [NCT03605420] was carried out according to the CONSORT criteria. Thirty-eight relatives of ICU patients were recruited at an ICU and randomized into study groups. Experimental group participants (n = 19) consisted of relatives who received 1 ICU visit prior to the patient's admission. Control group participants (n = 19) consisted of patients' relatives who received standard care alone. A self-report test battery, including the Impact of Event Scale-Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS), was completed by the patient's relative prior to the patient's ICU admission and again three and 90 days after ICU discharge. Furthermore, the Family Satisfaction with Care in the Intensive Care Unit (FS-ICU) and Critical Care Family Needs Inventory (CCFNI) were administered to help determine the respondents' satisfaction three days after the patient's ICU discharge. RESULTS Statistically significant differences in FS-ICU results were found between control and experimental groups; no statistically significant differences were found in IES-R, HADS, and CCFNI results. Thus, members in the control group were more satisfied with the time elapsed to raise their concerns (p=0.005), emotional support provided (p=0.020), quality of care (p=0.035), opportunities to express concerns and ask questions (p=0.005), and general satisfaction with the ICU's decision-making (p=0.003). CONCLUSIONS Relatives' satisfaction during patients' ICU admission may be impaired after their prior visit to the hospital admission. Relative's anxiety and depression scores did not seem to be significantly affected. Relatives´ visit prior to elective cardiac surgery hospital admission impaired their satisfaction in an ICU and may not be advisable for healthcare practice.
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Affiliation(s)
- Sara González-Martín
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Moisés Rodríguez-García
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Victoria Mazoteras-Pardo
- Department of Nursing, Physiotherapy and Occupational Therapy, School of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain
| | | | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, A Coruña, Spain
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Danesh V, Hecht J, Hao R, Boehm L, Jimenez EJ, Arroliga AC, Sanghi S, Stevens A. Peer Support for Post Intensive Care Syndrome Self-Management (PS-PICS): Study protocol for peer mentor training. J Adv Nurs 2021; 77:2092-2101. [PMID: 33432618 DOI: 10.1111/jan.14736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022]
Abstract
AIMS The primary aim of the Peer Support for Post Intensive Care Syndrome Self-Management (PS-PICS) peer mentor training trial is to determine the feasibility for peer mentor training to connect new ICU survivors with survivors who have made successful recoveries. Secondary aims are to also examine peer mentor eligibility, recruitment and retention rates and assess changes in participant knowledge of Post Intensive Care Syndrome (PICS), reported symptoms and health-related quality of life. DESIGN Prospective clinical feasibility trial. METHODS This study received funding from the National Institutes of Health funded P30 Center for Excellence (2014-2020). Up to 20 adult patients who have had an ICU stay of 3 days or longer more than 3 months ago will be enrolled into the study. Participants will undergo a 6-week peer mentor training program to learn how to promote healthy self-management behaviours, social connections, and well-being using motivational interviewing (MI). Participants will complete surveys about their recovery at 3 points during the study: prior to training, 6 weeks post-training and 3 months post-training. Survey questions will be used to assess trends in participant social isolation, depression, functional status, and self-management behaviours. DISCUSSION Enrollment closes by December 2020. As a feasibility trial, power sufficient for hypothesis testing will not be available. However, study operations and intervention fidelity contribute to future research knowledge and participant characteristics and longitudinal outcomes will yield data on intervention feasibility. This study is the first use of embedding peer-led motivational interviewing training into a peer support intervention for ICU survivors. IMPACT Current self-management interventions are limited for ICU survivors and do not sufficiently address barriers to promoting self-management behaviours or improving their health status, well-being and cost of health. This study will provide data to develop and implement interventions for the self-management of PICS-related symptoms and sequelae.
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Affiliation(s)
- Valerie Danesh
- School of Nursing, University of Texas at Austin, Austin, TX, USA.,Center for Applied Health Research, Baylor Scott & White Research Institute, Temple, TX, USA
| | - Jacki Hecht
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Richard Hao
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Leanne Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | | | | | - Sandhya Sanghi
- Center for Applied Health Research, Baylor Scott & White Research Institute, Temple, TX, USA
| | - Alan Stevens
- Center for Applied Health Research, Baylor Scott & White Research Institute, Temple, TX, USA
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Health problems among family caregivers of former intensive care unit (ICU) patients: an interview study. BJGP Open 2020; 4:bjgpopen20X101061. [PMID: 32843332 PMCID: PMC7606151 DOI: 10.3399/bjgpopen20x101061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/16/2020] [Indexed: 01/04/2023] Open
Abstract
Background Family caregivers of former intensive care unit (ICU) patients may suffer from physical and mental problems owing to ICU hospitalisation of their loved ones. These problems can have a major impact on their daily lives. Little is known about experienced consequences of ICU hospitalisation on caregivers in general practice. Aim To explore health problems in family caregivers of former ICU patients and the consequences in their daily lives. Design & setting Semi-structured interviews with family caregivers of former critically ill patients treated in a Dutch ICU. Method Purposively sampled relatives of former ICU patients were interviewed between April and May 2019. Interviews were conducted until data saturation was reached. Interviews were then thematically analysed. Results In total, 13 family caregivers were interviewed. The interviews took place 3 months to 3 years after ICU discharge. Expressed problems were categorised into six themes: (1) physical functioning (for example, tiredness, headache, and feeling sick more often); (2) mental health (for example, anxiety, more stress and difficulty in expressing emotions); (3) existential dimension and future (for example, uncertainty about the future); (4) quality of life (for example, losing freedom in life); (5) relationship and social participation (for example, experiencing a lack of understanding); and (6) daily functioning (for example, stopping working). Conclusion Caregivers experience several health problems, even years after their relative's ICU episode. Healthcare providers should be focused not only on former ICU patients’ health, but also on their caregivers’, and need to signal and identify caregivers' health problems earlier in order to give them the appropriate care and support they need.
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Psychological Sequelae in Family Caregivers of Critically III Intensive Care Unit Patients. A Systematic Review. Ann Am Thorac Soc 2020; 16:894-909. [PMID: 30950647 DOI: 10.1513/annalsats.201808-540sr] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Family members of critically ill patients hospitalized in the intensive care unit (ICU) often become caregivers, and they are at risk to develop adverse psychological outcomes. There is a need to understand the psychological impact of critical illness on family caregivers. Objectives: The aim of this systematic review is to document the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) in family caregivers of critically ill patients and identify potential risk factors for psychological outcomes to inform clinical and future research recommendations. Methods: A literature search for psychological outcomes for family caregivers of critically ill patients was conducted. A total of 1,148 studies from PsycINFO, CINAHL, Web of Science, SCOPUS, and Medline were identified. Results: Forty studies met inclusion criteria and were included in the review. The prevalence of psychological outcomes in family caregivers ranged from 4% to 94% for depression, 2% to 80% for anxiety, and 3% to 62% for PTSD. Caregiver depression, anxiety, and PTSD decreased in most studies that assessed longitudinal outcomes. Common risk factors identified for adverse psychological outcomes included younger caregiver age, caregiver relationship to the patient, lower socioeconomic status, and female sex. Conclusions: The prevalence of depression, anxiety, and PTSD varies greatly across studies of family caregivers of critically ill patients. This finding highlights the need for more systematic investigations of psychological outcomes and the implementation of clinical interventions to prevent or reduce depression, anxiety, and PTSD in family caregivers of critically ill patients.
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Boitor M, Martorella G, Maheu C, Laizner AM, Gélinas C. Effects of Massage in Reducing the Pain and Anxiety of the Cardiac Surgery Critically Ill-a Randomized Controlled Trial. PAIN MEDICINE 2019; 19:2556-2569. [PMID: 29618079 DOI: 10.1093/pm/pny055] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To evaluate the effectiveness of hand massage on the pain and anxiety of the cardiac surgery critically ill. Design A three-arm randomized controlled trial. Setting This study was conducted in a medical-surgical intensive care unit in Canada. Subjects Adult patients who underwent elective cardiac surgery, who were able to speak French/English and to self-report symptoms, without a high risk of postoperative complications were eligible. Methods Patients were randomly allocated to standard care plus either two 20-minute hand massages (experimental), two 20-minute hand holdings (active control), or two 20-minute rest periods (passive control/standard care). Pain intensity, pain unpleasantness, anxiety, muscle tension, and vital signs were evaluated before, after, and 30 minutes later for each intervention. Results From the 83 patients recruited, 60 were randomized (20 massage, 19 hand holding, 21 standard care). After controlling for baseline scores, the massage group reported significantly lower pain intensity, pain unpleasantness, and anxiety for the first data collection set compared with both hand holding and standard care (analysis of covariance, P < 0.02), with an average decrease of two points on a 0-10 scale. No statistically significant differences were noted between hand holding and standard care for any of the symptoms. Similar results were observed for the second data collection set (N = 43). Patients had decreased muscle tension post massage. Vital signs did not differ significantly between groups. Conclusions Findings suggest that a 20-minute hand massage in addition to routine postoperative pain management can concomitantly reduce pain intensity, pain unpleasantness, and anxiety by two points on average on a 0-10 scale.
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Affiliation(s)
- Madalina Boitor
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, 104F - Vivian M. Duxbury Hall, Florida, USA
| | - Christine Maheu
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
| | - Andréa Maria Laizner
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
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Scott P, Thomson P, Shepherd A. Families of patients in ICU: A Scoping review of their needs and satisfaction with care. Nurs Open 2019; 6:698-712. [PMID: 31367391 PMCID: PMC6650754 DOI: 10.1002/nop2.287] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 11/09/2022] Open
Abstract
AIM To describe published literature on the needs and experiences of family members of adults admitted to intensive care and interventions to improve family satisfaction and psychological well-being and health. DESIGN Scoping review. METHODS Several selective databases were searched. English-language articles were retrieved, and data extracted on study design, sample size, sample characteristics and outcomes measured. RESULTS From 469 references, 43 studies were identified for inclusion. Four key themes were identified: (a) Different perspectives on meeting family needs; (b) Family satisfaction with care in intensive care; (c) Factors having an impact on family health and well-being and their capacity to cope; and (d) Psychosocial interventions. Unmet informational and assurance needs have an impact on family satisfaction and mental health. Structured written and oral information shows some effect in improving satisfaction and reducing psychological burden. Future research might include family in the design of interventions, provide details of the implementation process and have clearly identified outcomes.
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Affiliation(s)
- Pamela Scott
- Intensive Care UnitForth Valley Royal HospitalLarbertUK
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Pre-surgical Caregiver Burden and Anxiety Are Associated with Post-Surgery Cortisol over the Day in Caregivers of Coronary Artery Bypass Graft Surgery Patients. Int J Behav Med 2019; 26:316-322. [PMID: 30793258 PMCID: PMC6529383 DOI: 10.1007/s12529-019-09775-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background The relationship between pre-surgical distress and diurnal cortisol following surgery has not been investigated prospectively in caregivers of coronary artery bypass graft (CABG) patients before. We aimed to examine the relationship between pre-surgical anxiety and caregiver burden and diurnal cortisol measured 2 months after the surgery in the caregivers of CABG patients. Method We used a sample of 103 caregivers of elective CABG patients that were assessed 28.86 days before and 60.94 days after patients’ surgery. Anxiety and caregiver burden were assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale and the Oberst Burden Scale respectively. Saliva samples were collected to measure cortisol area under the curve with respect to ground (AUCg) and diurnal cortisol slope. Anxiety and caregiver burden were entered into linear regression models simultaneously. Results While high levels of pre-surgical anxiety were positively associated with increased follow-up levels of AUCg (β = 0.30, p = 0.001), greater pre-surgery perceived burden score was associated with steeper cortisol slope (β = 0.27, p = 0.017) after controlling for a wide range of covariates. Conclusion These outcomes support the utility of psychological interventions aimed to increase the awareness of caregiving tasks and demands in informal caregivers.
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Effectiveness of Nurse's Intentional Presence as a Holistic Modality on Depression, Anxiety, and Stress of Cardiac Surgery Patients. Holist Nurs Pract 2018; 32:296-306. [PMID: 30320654 DOI: 10.1097/hnp.0000000000000294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the important aspects of recovering after bypass surgery is mental disorders of patients. Despite the importance of intentional presence in interpersonal interactive space in holistic nursing, a few experimental and clinical trial studies are conducted on this subject. This study determines the effect of intentional presence of a holistic nurse on anxiety, stress, and depression in patients undergoing coronary artery bypass graft surgery. The study used a randomized clinical trial conducted on 80 patients referred to heart surgery department from March 2016 to June 2017, who were allocated to the control and intervention groups randomly. DASS 21 (Depression, Anxiety, Stress scale) questionnaire and a checklist to determine stressor resources were used to measure the variables. Four 30- to 45-minute sessions of nursing intentional presence were conducted for each patient individually in the intervention group. The results showed homogeneity between 2 groups in demographic variables (P > .05). But there was heterogeneity between 2 groups (P < .05) for some stressors. By using analysis of covariance and excluding the effect of stressors and the first scores before the intervention, statistics represented a significant decrease in stress, anxiety, and depression scores in the intervention group compared with the control group (P < .0001). The results of this study indicated that the intentional presence of a nurse as an effective nursing procedure can reduce the depression, stress, and anxiety of the patients undergoing coronary artery bypass surgery.
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Nasiry D, Tavakoli A, Saber-Moghadam M. The Relationship Between Sleep Quality and General Health in Patients With Heart Failure. JOURNAL OF HOLISTIC NURSING AND MIDWIFERY 2018. [DOI: 10.29252/hnmj.28.4.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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15
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Choi J, Lingler JH, Donahoe MP, Happ MB, Hoffman LA, Tate JA. Home discharge following critical illness: A qualitative analysis of family caregiver experience. Heart Lung 2018; 47:401-407. [PMID: 29731146 PMCID: PMC6026552 DOI: 10.1016/j.hrtlng.2018.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few studies have longitudinally explored the experience and needs of family caregivers of ICU survivors after patients' home discharge. METHODS Qualitative content analysis of interviews drawn from a parent study that followed family caregivers of adults ICU survivors for 4 months post-ICU discharge. RESULTS Family caregivers (n = 20, all white, 80% woman) viewed home discharge as positive progress, but reported having insufficient time to transition from family visitor to the active caregiver role. Caregivers expressed feelings of relief during the steady recovery of family members' physical and cognitive function. However, the slow pace of improvement conflicted with their expectations. Even after patients achieved independent physical function, emotional needs persisted and these issues contributed to caregivers' anxiety, worry, and view that recovery was incomplete. CONCLUSION Family caregivers of ICU survivors need information and skills to help managing patients' care needs, pacing expectations with actual patients' progress, and caregivers' health needs.
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Affiliation(s)
- JiYeon Choi
- Department of Acute and Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA; Yonsei University College of Nursing, Seoul, Republic of Korea.
| | - Jennifer H Lingler
- Department of Health and Community Systems, University of Pittsburg, School of Nursing, Pittsburgh, PA, USA
| | - Michael P Donahoe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Mary Beth Happ
- Center of Excellence in Critical and Complex Care, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Leslie A Hoffman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Judith A Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
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16
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Oliveira HSBD, Fumis RRL. Sex and spouse conditions influence symptoms of anxiety, depression, and posttraumatic stress disorder in both patients admitted to intensive care units and their spouses. Rev Bras Ter Intensiva 2018; 30:35-41. [PMID: 29742213 PMCID: PMC5885229 DOI: 10.5935/0103-507x.20180004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/24/2017] [Indexed: 11/28/2022] Open
Abstract
Objectives To assess the effect of sex and spouse condition on symptoms of anxiety,
depression and posttraumatic stress symptoms in patients and their
spouses. Methods A prospective study conducted in a 22-bed adult mixed intensive care unit in
a tertiary hospital in São Paulo, Brazil. Patients and their spouses
were enrolled 2 days after intensive care unit admission. They were
interviewed while in the intensive care unit using the Hospital Anxiety and
Depression Scale. At 30 and 90 days after intensive care unit discharge,
they completed the Impact of Event Scale and Hospital Anxiety and Depression
Scale by phone. Results From March 2011 to March 2013, we analyzed 118 patients and their spouses. We
observed that female sex was associated with higher scores than male sex was
in terms of the anxiety Hospital Anxiety and Depression Scale - subscale (p
= 0.032) and depression (p = 0.034). There was no association between sex
and posttraumatic stress disorder symptoms. However, spouses had higher
Impact of Event Scale points compared with patients (p = 0.001). Conclusions Female sex was associated with anxiety and depression, and spouses were more
vulnerable to post-traumatic stress symptoms than the patients were.
Increasing age and a later time of assessment were also associated with
lower scores on the Impact of Event Scale.
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17
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Abstract
The purpose of this study was to examine the effects of family presence during resuscitation (FPDR) in patients who survived trauma from motor vehicle crashes (MVC) and gunshot wounds (GSW). A convenience sample of family members participated within three days of admission to critical care. Family members of 140 trauma patients (MVC n = 110, 79%; GSW n = 30, 21%) participated. Family members ranged in age from 20-84 years (M = 46, SD = 15, Mdn = 47). The majority were female (n = 112, 80%) and related to the patient as spouse (n = 46, 33%). Participating in the FPDR option reduced anxiety (t = -2.43, p =.04), reduced stress (t = -2.86, p = .005), and fostered well-being (t = 3.46, p = .001). Results demonstrate the positive initial effects of FPDR on family members of patients surviving trauma injury.
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Affiliation(s)
- Jane S. Leske
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee WI
- Froedtert and the Medical College of Wisconsin-Froedtert Hospital, Milwaukee WI
| | - Natalie S. McAndrew
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee WI
- Froedtert and the Medical College of Wisconsin-Froedtert Hospital, Milwaukee WI
| | - Karen J. Brasel
- Oregon Heath & Science University, Division of Trauma, Critical Care & Acute Care Surgery, Portland OR
| | - Suzanne Feetham
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee WI
- Children’s National Health System, Washington DC
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18
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Posttraumatic Stress Disorder After Discharge From Intensive Care Units in Greater Athens Area. J Trauma Nurs 2017; 22:209-17. [PMID: 26165874 DOI: 10.1097/jtn.0000000000000142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Survivors of critical illnesses often exhibit high psychiatric morbidity. The aim of this study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and the comorbidity between PTSD and major depression, among patients who have been treated in a general (medical-surgical) intensive care unit (ICU group) compared with patients who have been treated in a non-ICU department, medical or surgical (non-ICU group). The study was conducted in 5 general hospitals in the greater Athens, Greece area. The final sample of the study was composed of 198 patients. The point prevalence of PTSD for ICU patients was 35.3%, whereas for non-ICU patients it was 13.5%. In this study, 11.6% of the sample was found to meet the criteria for both PTSD and major depression. The clinical entity of PTSD is common after intensive care treatment, and coordination between health care professionals is necessary for early recognition and treatment of any psychiatric complication.
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19
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Boitor M, Martorella G, Laizner AM, Maheu C, Gélinas C. The Effectiveness of Hand Massage on Pain in Critically Ill Patients After Cardiac Surgery: A Randomized Controlled Trial Protocol. JMIR Res Protoc 2016; 5:e203. [PMID: 27821384 PMCID: PMC5118583 DOI: 10.2196/resprot.6277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 01/20/2023] Open
Abstract
Background Postoperative pain is common in the intensive care unit despite the administration of analgesia. Some trials suggest that massage can be effective at reducing postoperative pain in acute care units; however, its effects on pain relief in the intensive care unit and when pain severity is highest remain unknown. Objective The objective is to evaluate the effectiveness of hand massage on the pain intensity (primary outcome), unpleasantness and interference, muscle tension, anxiety, and vital signs of critically ill patients after cardiac surgery. Methods A 3-arm randomized controlled trial will be conducted. A total of 79 patients who are 18 years or older, able to speak French or English and self-report symptoms, have undergone elective cardiac surgery, and do not have a high risk of postoperative complications and contraindications to hand massage will be recruited. They will be randomly allocated (1:1:1) to standard care plus either 3 20-minute hand massages (experimental), 3 20-minute hand holdings (active control), or 3 20-minute rest periods (passive control). Pain intensity, unpleasantness, anxiety, muscle tension, and vital signs will be evaluated before, immediately after, and 30 minutes later for each intervention administered within 24 hours postoperatively. Peer-reviewed competitive funding was received from the Quebec Nursing Intervention Research Network and McGill University in December 2015, and research ethics approval was obtained February 2016. Results Recruitment started in April 2016, and data collection is expected to be complete by January 2017. To date, 24 patients were randomized and had data collection done. Conclusions This study will be one of the first randomized controlled trials to examine the effect of hand massage on the pain levels of critically ill patients after cardiac surgery and to provide empirical evidence for the use of massage among this population. ClinicalTrial ClinicalTrials.gov NCT02679534; https://clinicaltrials.gov/ct2/show/NCT02679534 (Archived by WebCite at http://www.webcitation.org/6l8Ly5eHS)
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Affiliation(s)
- Madalina Boitor
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Andréa Maria Laizner
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Christine Maheu
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Céline Gélinas
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
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20
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Köse I, Zincircioğlu Ç, Öztürk YK, Çakmak M, Güldoğan EA, Demir HF, Şenoglu N, Erbay RH, Gonullu M. Factors Affecting Anxiety and Depression Symptoms in Relatives of Intensive Care Unit Patients. J Intensive Care Med 2016; 31:611-7. [DOI: 10.1177/0885066615595791] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/23/2015] [Indexed: 11/16/2022]
Abstract
Aim: To determine the incidences of anxiety and depression in relatives of patients admitted to an intensive care unit (ICU) and to investigate the relationships between psychological symptoms and demographic features of the patients and their relatives. Methodology: Relatives of 78 ICU patients were enrolled in the study. Sociodemographic features of patients and their relatives were recorded. The Turkish version of the Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Results: Twenty-eight (35.9%) cases with anxiety and 56 (71.8%) cases with depression were identified. The mean anxiety and depression scores were 9.49 ± 4.183 and 9.40 ± 4.286, respectively. Anxiety ( P = .028) and concomitant anxiety with depression ( P = .035) were more frequent among family members of young patients. The relationship to the patient, especially being a spouse, was significantly associated with symptoms (anxiety, P = .009; depression, P = .019; and both, P = .005). Conclusion: Spouses and family members of relatively young patients had higher rates of anxiety and depression. In contrast to the literature, depression was more common than anxiety among the relatives of ICU patients. Further research is needed on the impact of cultural and regional differences on anxiety and depression rates in family members of ICU patients.
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Affiliation(s)
- Işıl Köse
- Department of Anesthesiology and Reanimation, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Çiler Zincircioğlu
- Department of Anesthesiology and Reanimation, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Yasemin Kılıç Öztürk
- Department of Family Medicine, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Meltem Çakmak
- Department of Anesthesiology and Reanimation, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | | | - Hafize Fisun Demir
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Nimet Şenoglu
- Department of Anesthesiology and Reanimation, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Rıza Hakan Erbay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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21
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Frivold G, Slettebø Å, Dale B. Family members’ lived experiences of everyday life after intensive care treatment of a loved one: a phenomenological hermeneutical study. J Clin Nurs 2016; 25:392-402. [DOI: 10.1111/jocn.13059] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Gro Frivold
- Faculty of Health and Sport Sciences; University of Agder; Grimstad Norway
| | - Åshild Slettebø
- Faculty of Health and Sport Sciences; University of Agder; Grimstad Norway
| | - Bjørg Dale
- Faculty of Health and Sport Sciences; University of Agder; Grimstad Norway
- Centre for Caring Research - Southern Norway; University of Agder; Grimstad Norway
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22
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van Beusekom I, Bakhshi-Raiez F, de Keizer NF, Dongelmans DA, van der Schaaf M. Reported burden on informal caregivers of ICU survivors: a literature review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:16. [PMID: 26792081 PMCID: PMC4721206 DOI: 10.1186/s13054-016-1185-9] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Critical illness and the problems faced after ICU discharge do not only affect the patient, it also negatively impacts patients' informal caregivers. There is no review which summarizes all types of burden reported in informal caregivers of ICU survivors. It is important that the burdens these informal caregivers suffer are systematically assessed so the caregivers can receive the professional care they need. We aimed to provide a complete overview of the types of burdens reported in informal caregivers of adult ICU survivors, to make recommendations on which burdens should be assessed in this population, and which tools should be used to assess them. METHOD We performed a systematic search in PubMed and CINAHL from database inception until June 2014. All articles reporting on burdens in informal caregivers of adult ICU survivors were included. Two independent reviewers used a standardized form to extract characteristics of informal caregivers, types of burdens and instruments used to assess these burdens. The quality of the included studies was assessed using the Newcastle-Ottawa and the PEDro scales. RESULTS The search yielded 2704 articles, of which we included 28 in our review. The most commonly reported outcomes were psychosocial burden. Six months after ICU discharge, the prevalence of anxiety was between 15% and 24%, depression between 4.7% and 36.4% and post-traumatic stress disorder (PTSD) between 35% and 57.1%. Loss of employment, financial burden, lifestyle interference and low health-related quality of life (HRQoL) were also frequently reported. The most commonly used tools were the Hospital Anxiety and Depression Scale (HADS), Centre for Epidemiological Studies-Depression questionnaire, and Impact of Event Scale (IES). The quality of observational studies was low and of randomized studies moderate to fair. CONCLUSIONS Informal caregivers of ICU survivors suffer a substantial variety of burdens. Although the quality of the included studies was poor, there is evidence that burden in the psychosocial field is most prevalent. We suggest screening informal caregivers of ICU survivors for anxiety, depression, PTSD, and HRQoL using respectively the HADS, IES and Short Form 36 and recommend a follow-up period of at least 6 months.
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Affiliation(s)
- Ilse van Beusekom
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,National Intensive Care Evaluation, Amsterdam, The Netherlands.
| | - Ferishta Bakhshi-Raiez
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,National Intensive Care Evaluation, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,National Intensive Care Evaluation, Amsterdam, The Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam School of Health Professions, University of Applied Sciences, Amsterdam, The Netherlands
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23
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Ågård AS, Egerod I, Tønnesen E, Lomborg K. From spouse to caregiver and back: a grounded theory study of post-intensive care unit spousal caregiving. J Adv Nurs 2015; 71:1892-903. [DOI: 10.1111/jan.12657] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Sophie Ågård
- Department of Anesthesiology and Intensive Care; Aarhus University Hospital; Denmark
| | - Ingrid Egerod
- University of Copenhagen, Health & Medical Sciences; Copenhagen University Hospital Rigshospitalet; Trauma Center; Denmark
| | - Else Tønnesen
- Department of Anesthesiology and Intensive Care; Aarhus University Hospital; Denmark
| | - Kirsten Lomborg
- Faculty of Health Sciencies & Aarhus University Hospital; Aarhus University; Denmark
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24
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Fumis RRL, Ranzani OT, Martins PS, Schettino G. Emotional disorders in pairs of patients and their family members during and after ICU stay. PLoS One 2015; 10:e0115332. [PMID: 25616059 PMCID: PMC4304779 DOI: 10.1371/journal.pone.0115332] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/21/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients and family members undergo different experiences of suffering from emotional disorders during ICU stay and after ICU discharge. The purpose of this study was to compare the incidence of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in pairs (patient and respective family member), during stay at an open visit ICU and at 30 and 90-days post-ICU discharge. We hypothesized that there was a positive correlation with the severity of symptoms among pairs and different patterns of suffering over time. METHODS A prospective study was conducted in a 22-bed adult general ICU including patients with >48 hours stay. The Hospital Anxiety and Depression Scale (HADS) was completed by the pairs (patients/respective family member). Interviews were made by phone at 30 and 90-days post-ICU discharge using the Impact of Event Scale (IES) and the HADS. Multivariate models were constructed to predict IES score at 30 days for patients and family members. RESULTS Four hundred and seventy one family members and 289 patients were interviewed in the ICU forming 184 pairs for analysis. Regarding HADS score, patients presented less symptoms than family members of patients who survived and who deceased at 30 and 90-days (p<0.001). However, family members of patients who deceased scored higher anxiety and depression symptoms (p = 0.048) at 90-days when compared with family members of patients who survived. Patients and family members at 30-days had a similar IES score, but it was higher in family members at 90-days (p = 0.019). For both family members and patients, age and symptoms of anxiety and depression during ICU were the major determinants for PTSD at 30-days. CONCLUSIONS Anxiety, depression and PTSD symptoms were higher in family members than in the patients. Furthermore, these symptoms in family members persisted at 3 months, while they decreased in patients.
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Affiliation(s)
- Renata Rego Lins Fumis
- Intensive Care Unit, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil
- * E-mail:
| | - Otavio T. Ranzani
- Respiratory Intensive Care Unit, Pulmonary Division, Heart Institute, Hospital das Clínicas, University of São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, São Paulo 05403-900, Brazil
| | - Paulo Sérgio Martins
- Intensive Care Unit, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil
| | - Guilherme Schettino
- Intensive Care Unit, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil
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Carlson EB, Spain DA, Muhtadie L, McDade-Montez L, Macia KS. Care and caring in the intensive care unit: Family members' distress and perceptions about staff skills, communication, and emotional support. J Crit Care 2015; 30:557-61. [PMID: 25682345 DOI: 10.1016/j.jcrc.2015.01.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Family members of intensive care unit (ICU) patients are sometimes highly distressed and report lower satisfaction with communication and emotional support from staff. Within a study of emotional responses to traumatic stress, associations between family distress and satisfaction with aspects of ICU care were investigated. MATERIALS AND METHODS In 29 family members of trauma patients who stayed in an ICU, we assessed symptoms of depression and posttraumatic stress disorder (PTSD) during ICU care. Later, family members rated staff communication, support, and skills and their overall satisfaction with ICU care. RESULTS Ratings of staff competence and skills were significantly higher than ratings of frequency of communication, information needs being met, and support. Frequency of communication and information needs being met were strongly related to ratings of support (rs = .75-.77) and staff skills (rs = .77-.85), and aspects of satisfaction and communication showed negative relationships with symptoms of depression (rs = -.31 to -.55) and PTSD (rs = -.17 to -.43). CONCLUSIONS Although satisfaction was fairly high, family member distress was negatively associated with several satisfaction variables. Increased understanding of the effects of traumatic stress on family members may help staff improve communication and increase satisfaction of highly distressed family members.
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Affiliation(s)
- Eve B Carlson
- National Center for Posttraumatic Stress Disorder and VA Palo Alto Health Care System, Department of Veterans Affairs, 795 Willow Road (334/NC-PTSD), Menlo Park, CA 94025, USA.
| | - David A Spain
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Dr., A160 MC 5313, Stanford, CA 94305, USA
| | - Luma Muhtadie
- National Center for Posttraumatic Stress Disorder and VA Palo Alto Health Care System, Department of Veterans Affairs, 795 Willow Road (334/NC-PTSD), Menlo Park, CA 94025, USA
| | - Liz McDade-Montez
- National Center for Posttraumatic Stress Disorder and VA Palo Alto Health Care System, Department of Veterans Affairs, 795 Willow Road (334/NC-PTSD), Menlo Park, CA 94025, USA
| | - Kathryn S Macia
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA
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Effect of Anxiety on Individuals and Caregivers After Coronary Artery Bypass Grafting Surgery. Dimens Crit Care Nurs 2015; 34:285-8. [DOI: 10.1097/dcc.0000000000000137] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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27
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Asimakopoulou E, Madianos M. The prevalence of major depression-PTSD comorbidity among ICU survivors in five general hospitals of Athens: a cross-sectional study. Issues Ment Health Nurs 2014; 35:954-63. [PMID: 25325150 DOI: 10.3109/01612840.2014.924609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Recent progress in medicine and technology has produced a significant increase in the survival rate of critically ill patients. The aim of this study was to investigate the prevalence of major depression and post-traumatic stress disorder (PTSD) comorbidity among patients after discharge from the intensive care unit (ICU) and to compare it with patients who were discharged from the internal or surgical department. The study was conducted in five general hospitals in the greater Athens area. The sample of the research was composed of 198 patients. The point prevalence of major depression for ICU patients was 32.3%, while for non-ICU patients, it was 19.8%. In this study, 11.6% of the sample was found to meet the criteria for both major depression and PTSD. Early recognition and treatment of major depression and PTSD in critically ill patients could contribute to improved quality of life.
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Affiliation(s)
- Evanthia Asimakopoulou
- Department of Mental Health and Behavioral Sciences, School of Nursing, National and Kapodistrian University of Athens , Greece
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28
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Ladwig KH, Lederbogen F, Albus C, Angermann C, Borggrefe M, Fischer D, Fritzsche K, Haass M, Jordan J, Jünger J, Kindermann I, Köllner V, Kuhn B, Scherer M, Seyfarth M, Völler H, Waller C, Herrmann-Lingen C. Position paper on the importance of psychosocial factors in cardiology: Update 2013. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2014; 12:Doc09. [PMID: 24808816 PMCID: PMC4012565 DOI: 10.3205/000194] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 12/30/2022]
Abstract
Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008. Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients. Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted cardioverter defibrillators (ICDs) a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered. Conclusions: The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine.
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Affiliation(s)
- Karl-Heinz Ladwig
- Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Epidemiologie-2, Helmholtz-Zentrum München, Neuherberg, Germany ; Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum Rechts der Isar der TU München, Germany
| | - Florian Lederbogen
- Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Medizinische Fakultät Mannheim, Germany
| | - Christian Albus
- Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln, Germany
| | | | - Martin Borggrefe
- I. Medizinische Klinik für Kardiologie, Angiologie, Pneumologie, Internistische Intensivmedizin und Hämostaseologie, Universitätsmedizin Mannheim, Germany
| | - Denise Fischer
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Kurt Fritzsche
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Germany
| | - Markus Haass
- Innere Medizin II: Kardiologie, Angiologie und Internistische Intensivmedizin, Theresienkrankenhaus und St. Hedwig-Klinik, Mannheim, Germany
| | - Jochen Jordan
- Herz-, Thorax- und Rheumazentrum, Abteilung für Psychokardiologie, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Jana Jünger
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Universität Heidelberg, Germany
| | - Ingrid Kindermann
- Innere Medizin III (Kardiologie/Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Volker Köllner
- Medizinische Fakultät, Universität des Saarlandes, Blieskastel, Germany
| | - Bernhard Kuhn
- Fachpraxis für Innere Medizin, Kardiologie, Angiologie und Notfallmedizin, Heidelberg, Germany
| | - Martin Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Melchior Seyfarth
- Medizinische Klinik 3 (Kardiologie), Helios-Klinikum Wuppertal-Herzzentrum, Universität Witten/Herdecke, Wuppertal, Germany
| | - Heinz Völler
- Fachklinik für Innere Medizin, Abteilung Kardiologie, Klinik am See, Rüdersdorf, Germany
| | - Christiane Waller
- Abteilung Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Germany
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Scott T, Davies M, Dutton C, Cummings I, Burden B, England K, Wood P. Intensive Care Follow-up in UK Military Casualties: A One-Year Pilot. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Military casualties requiring intensive care were reviewed in a pilot follow-up clinic at approximately three to six months post discharge. All patients reviewed had suffered traumatic injuries in Afghanistan with a median New Injury Severity Score (NISS) of 41. Approximately 50% of casualties reviewed reported hallucinations while on ICU which were often intense and unpleasant. The predominant sedative agents used were morphine and midazolam. Occipital alopecia and pressure sores were reported as an unexpected finding in 35% of casualties. This appears to be permanent in 25% of cases and has required surgery in a small number of cases. Personality changes and anger are common and this cohort of patients can be sensitive to perceived stigmatising concerns regarding referral to psychiatric support services. Patient diaries, which were begun on intensive care in Afghanistan and continued through until discharge in the UK, were found to be very helpful. A significant proportion of clinic attendees thought the pilot clinic was helpful with a quarter of survey responders finding it very helpful. However, this was commonly based on the perception that they were helping the defence medical services improve delivery of care.
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Affiliation(s)
- Timothy Scott
- Surgeon Commander, Anaesthetic Department, John Radcliffe Hospital, Oxford
| | - Matthew Davies
- Wing Commander, Anaesthetic Department, Peterborough City Hospital, Peterborough
| | - Clare Dutton
- Major, Deputy OC Nursing, Defence Medical Rehabilitation Centre, Headley Court, Surrey
| | - Iain Cummings
- Squadron Leader, Department of Anaesthesia, Royal Victoria Infirmary, Newcastle-Upon-Tyne
| | - Bev Burden
- Captain, Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Birmingham
| | - Kaye England
- Consultant Intensive Care Physician, Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Birmingham
| | - Paul Wood
- Consultant Anaesthetist, Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Birmingham
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Anxiety and depression symptoms among families of adult intensive care unit survivors immediately following brief length of stay. J Crit Care 2014; 29:278-82. [DOI: 10.1016/j.jcrc.2013.11.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/26/2013] [Accepted: 11/28/2013] [Indexed: 11/20/2022]
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Abstract
Despite extraordinary innovations in cardiology and critical care, cardiovascular disease remains the leading cause of death globally, and heart failure has one of the highest disease burdens of any medical condition in the Western world. The lethality of many cardiac conditions, for which symptoms and prognoses are worse than for many malignancies, is widely under-recognized. A number of strategies have been developed within specialties such as oncology to improve the care of patients with life-threatening conditions. For reasons that are multifactorial, these options are often denied to critically ill patients with cardiac disease. Cardiologists and intensivists often regard death as failure, continuing to pursue active treatment while potentially denying patients access to alternatives such as symptom control and end-of-life care. Patient autonomy is central to the delivery of high-quality care, demanding shared decision-making to ensure patient preferences are acknowledged and respected. Although many cardiologists and intensivists do provide thoughtful and patient-centred care, the pressure to intervene can lead to physician-centric care focused around the needs and wishes of medical staff to the detriment of patients, families, health-care workers, and society as a whole.
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SCHINDLER AW, SCHINDLER N, ENZ F, LUECK A, OLDEROG T, VAGTS DA. ICU personnel have inaccurate perceptions of their patients' experiences. Acta Anaesthesiol Scand 2013; 57:1032-40. [PMID: 23819844 DOI: 10.1111/aas.12148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intensive care unit (ICU) patient care bases - among others - upon the staff's assumptions about each patient's subjective preferences and experiences. However, these assumptions may be skewed and thus result in client-professional gaps (cp-gaps), which occur in two subtypes, hyperattention and blind spots to certain burdens. cp-gaps typically reduce quality of care. We investigated whether cp-gaps of either subtype exist in a 36-bed ICU of a university hospital. METHODS Observational study on 82 consecutive patients of a 36-bed university ICU, who voluntarily answered a psychometric questionnaire focusing on patients' experiences during an ICU stay. The questionnaire was reliable and valid (Cronbach's alpha, factor analysis). It consisted of 31 Likert-scaled items, which represented three scales of perception (communicative, intrapersonal, somatic) supplemented by 55 binary items for more specific information. Details of the questionnaire are given in the text. Demographic, educational, and medical data were registered too. Patients reported their subjective ICU experience 2-7 days after ICU discharge. Analogously, 60 staff members (physicians and nurses) reported their assumptions about patients' experiences. After correction for a general bias, group differences indicated cp-gaps. RESULTS Twelve cp-gaps were found. Hyperattention was found in four communicative and three intrapersonal items. Blind spots appeared in two communicative, two intrapersonal, and one somatic item. The pattern of cp-gap subtypes (hyperattention/blind spots) goes well with self-attributional bias - a model of social interaction. CONCLUSIONS cp-gaps in ICUs can be identified using analogue questionnaires for patients and staff. Both subtypes of cp-gap occur. cp-gaps are substantially influenced by self-attributional bias.
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Affiliation(s)
| | | | - F. ENZ
- Department of Anesthesiology and Intensive Care Medicine; University Hospital Rostock; Rostock; Germany
| | - A. LUECK
- Department of Anesthesiology and Intensive Care Medicine; University Hospital Rostock; Rostock; Germany
| | - T. OLDEROG
- Department of Anesthesiology and Intensive Care Medicine; Hetzelstift Hospital; Neustadt/Weinstraße; Germany
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Day A, Haj-Bakri S, Lubchansky S, Mehta S. Sleep, anxiety and fatigue in family members of patients admitted to the intensive care unit: a questionnaire study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R91. [PMID: 23705988 PMCID: PMC3706908 DOI: 10.1186/cc12736] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/24/2013] [Indexed: 02/05/2023]
Abstract
Introduction Family members of critically ill patients often experience increased incidence of physical and mental health issues. One of the first ways family members suffer is by losing sleep. The purpose of this study is to understand sleep quality, levels of fatigue and anxiety, and factors contributing to poor sleep in adult family members of critically ill patients. Methods A questionnaire was designed to evaluate sleep, fatigue and anxiety during the intensive care unit (ICU) admission. We incorporated three validated instruments: General Sleep Disturbance Scale (GSDS), Beck Anxiety Index (BAI) and Lee Fatigue Scale (NRS-F). Adult family members of patients in ICU for more than 24 hours were approached for questionnaire completion. Patient demographics were recorded. Results The study population consisted of 94 respondents, (49.1 ± 12.9 years, 52.7% male); 43.6% were children and 21.3% were spouses of ICU patients. Sleep quality was rated as poor/very poor by 43.5% of respondents, and good/very good by 15.2%. The most common factors contributing to poor sleep were anxiety (43.6%), tension (28.7%) and fear (24.5%). Respondents' most common suggestions to improve sleep were more information regarding the patient's health (24.5%) and relaxation techniques (21.3%). Mean GSDS score was 38.2 ± 19.3, with 58.1% of respondents experiencing moderate to severe sleep disturbance. Mean BAI was 12.3 ± 10.2, with 20.7% of respondents experiencing moderate to severe anxiety. Mean NRS-F was 3.8 ± 2.5, with 57.6% of respondents experiencing moderate to high fatigue. Family members who spent one or more nights in the hospital had significantly higher GSDS, BAI and NRS-F scores. The patient's Acute Physiology and Chronic Health Evaluation (APACHE) II score at survey completion correlated significantly with family members' GSDS, BAI and NRS-F. Conclusion The majority of family members of ICU patients experience moderate to severe sleep disturbance and fatigue, and mild anxiety.
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Wallin E, Larsson IM, Rubertsson S, Kristoferzon ML. Relatives' experiences of everyday life six months after hypothermia treatment of a significant other′s cardiac arrest. J Clin Nurs 2013; 22:1639-46. [DOI: 10.1111/jocn.12112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Ewa Wallin
- Department of Surgical Sciences - Anaesthesiology & Intensive Care; Uppsala University; Uppsala Sweden
| | - Ing-Marie Larsson
- Department of Surgical Sciences - Anaesthesiology & Intensive Care; Uppsala University; Uppsala Sweden
| | - Sten Rubertsson
- Department of Surgical Sciences - Anaesthesiology & Intensive Care; Uppsala University; Uppsala Sweden
| | - Marja-Leena Kristoferzon
- Faculty of Health and Occupational Studies; Department of Health and Caring Sciences; University of Gävle; Gävle Sweden
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
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Rodríguez Villar S, Sánchez Casado M, Prigerson HG, Mesa García S, Rodríguez Villar M, Hortigüela Martín VA, Marco Schulke CM, Barrientos Vega R, Quintana M, Leóz Abellanas G. [Incidence of prolonged grief disorder in relatives of patients who die during or after admission in Intensive Care Unit]. ACTA ACUST UNITED AC 2012; 59:535-41. [PMID: 22818955 DOI: 10.1016/j.redar.2012.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 05/23/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the incidence of «Prolonged Grief Disorder» from one year after the death of a relative admitted to the Intensive Care Unit. MATERIAL AND METHODS A cross-sectional, longitudinal follow-up study was conducted in a general ICU of a reference hospital. The relatives were evaluated approximately one year after the death using the «Consensus Criteria for Prolonged Grief Disorder» as a tool. The prevalence between the first and second years was determined. RESULTS A total of 151 relatives of patients who died in ICU were included. The follow-up was carried out 22.1±5.3 months after the death. Eleven relatives (10.3%) fulfilled the «Consensus Criteria for Prolonged Grief Disorder». Of all the grieving relatives, those identified with prolonged grief disorder are the ones who most often require psychological/psychiatric support. CONCLUSIONS In a sample of close relatives of patients who died in ICU, a significant minority fulfilled the criteria for «Prolonged Grief Disorder» 1-2 years after the death. This condition, which is often overlooked, and could require some kind of psychological treatment, should be taken into consideration.
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Affiliation(s)
- S Rodríguez Villar
- Servicio de Medicina Intensiva, Hospital General Ntra. Sra. del Prado, Toledo, España.
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Bäckström J, Ekselius L, Gerdin B, Willebrand M. Prediction of psychological symptoms in family members of patients with burns 1 year after injury. J Adv Nurs 2012; 69:384-93. [DOI: 10.1111/j.1365-2648.2012.06017.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Myhren H, Ekeberg Ø, Stokland O. Satisfaction with communication in ICU patients and relatives: comparisons with medical staffs' expectations and the relationship with psychological distress. PATIENT EDUCATION AND COUNSELING 2011; 85:237-44. [PMID: 21167672 DOI: 10.1016/j.pec.2010.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 11/11/2010] [Accepted: 11/21/2010] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To study intensive care unit (ICU) patients' and relatives' satisfaction in regard to communication with medical staff (nurses and physicians), perceived support, environmental strain and their psychological distress. Further, to compare this with expectations of the medical staff. METHODS Cross-sectional study, 4-6 weeks post-ICU discharge. Respondents to the questionnaire were: 255 (63%) patients, 354 (82%) relatives and 145 (74%) medical staff. Degree of satisfaction and distress were measured on a five-point Likert-scale (0=low to 4=high). RESULTS The mean score for patient satisfaction with communication was 3.0 (95%CI 2.9-3.1) and for relatives 3.4 (3.3-3.5). This was significantly higher than expected by the staff for patients 2.5 (2.4-2.6) and relatives 2.8 (2.7-2.9), both p<0.001. Relatives' degree of psychological distress, 2.5 (2.4-2.6) was significantly higher than for patients', 1.6 (1.5-1.7), but was significantly lower than expected by the staff, 2.9 (2.8-3.0) and 2.7 (2.6-2.8) respectively, both p<0.001. CONCLUSION Patients and relatives were more satisfied with the communication than expected by the staff. The staff overestimated the patients' and relatives' psychological distress. Relatives report more psychological distress symptoms post-ICU discharge compared to the patients. PRACTICE IMPLICATIONS Medical staff is aware of psychological distress in ICU patients and relatives and effort to reduce this during ICU stay and afterwards should be implemented.
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Affiliation(s)
- Hilde Myhren
- Intensive Care Unit, Oslo University Hospital, Ullevål, Norway.
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Symptom experiences of family members of intensive care unit patients at high risk for dying. Crit Care Med 2010; 38:1078-85. [DOI: 10.1097/ccm.0b013e3181cf6d94] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bailey JJ, Sabbagh M, Loiselle CG, Boileau J, McVey L. Supporting families in the ICU: A descriptive correlational study of informational support, anxiety, and satisfaction with care. Intensive Crit Care Nurs 2010; 26:114-22. [DOI: 10.1016/j.iccn.2009.12.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 12/03/2009] [Accepted: 12/17/2009] [Indexed: 10/19/2022]
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Albert NM, Gillinov AM, Lytle BW, Feng J, Cwynar R, Blackstone EH. A randomized trial of massage therapy after heart surgery. Heart Lung 2009; 38:480-90. [DOI: 10.1016/j.hrtlng.2009.03.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 01/22/2009] [Accepted: 03/10/2009] [Indexed: 11/24/2022]
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Davydow DS, Gifford JM, Desai SV, Bienvenu OJ, Needham DM. Depression in general intensive care unit survivors: a systematic review. Intensive Care Med 2009; 35:796-809. [PMID: 19165464 PMCID: PMC10885708 DOI: 10.1007/s00134-009-1396-5] [Citation(s) in RCA: 284] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 10/22/2008] [Indexed: 12/16/2022]
Abstract
PURPOSE To critically review data on the prevalence of depressive symptoms in general intensive care unit (ICU) survivors, risk factors for these symptoms, and their impact on health-related quality of life (HRQOL). METHODS We conducted a systematic review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO, and a hand-search of 13 journals. RESULTS Fourteen studies were eligible. The median point prevalence of "clinically significant" depressive symptoms was 28% (total n = 1,213). Neither sex nor age were consistent risk factors for post-ICU depression, and severity of illness at ICU admission was consistently not a risk factor. Early post-ICU depressive symptoms were a strong risk factor for subsequent depressive symptoms. Post-ICU depressive symptoms were associated with substantially lower HRQOL. CONCLUSIONS Depressive symptoms are common in general ICU survivors and negatively impact HRQOL. Future studies should address how factors related to individual patients, critical illness and post-ICU recovery are associated with depression in ICU survivors.
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Affiliation(s)
- Dimitry S Davydow
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Avenue, Box 356896, Seattle, WA 98104, USA.
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McAdam JL, Puntillo K. Symptoms experienced by family members of patients in intensive care units. Am J Crit Care 2009; 18:200-9; quiz 210. [PMID: 19411580 DOI: 10.4037/ajcc2009252] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Concern for the family members of patients who are at high risk of dying in intensive care units is both a necessary and integral part of providing holistic nursing care. When patients are at high risk of dying, their families experience burdens such as decision making and treatment choices that can cause the families psychological and physical symptoms, most commonly stress, anxiety, and depression. These symptoms in turn can affect family members' general well-being. Since the late 1990s, several quantitative and qualitative studies have been done to assess symptoms in such family members. In this review of the literature, the current state of the science on symptoms experienced by family members of patients in the intensive care unit is reviewed and critiqued. Risk factors associated with an increase in symptoms experienced are discussed. Overall, surveys that use self-report measures were the most common study design. Limitations of the studies include convenience sampling, small sample sizes, and a lack of description of patients' characteristics, all of which make comparison and use of findings difficult. Recommendations to address gaps in the literature are highlighted, and future research goals are discussed.
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Affiliation(s)
- Jennifer L. McAdam
- Jennifer L. McAdam is an assistant professor of nursing at the School of Nursing at Dominican University of California, San Rafael. Kathleen Puntillo is a professor of nursing in the Department of Physiological Nursing, School of Nursing, University of California, San Francisco
| | - Kathleen Puntillo
- Jennifer L. McAdam is an assistant professor of nursing at the School of Nursing at Dominican University of California, San Rafael. Kathleen Puntillo is a professor of nursing in the Department of Physiological Nursing, School of Nursing, University of California, San Francisco
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Family members of critically ill cancer patients: assessing the symptoms of anxiety and depression. Intensive Care Med 2009; 35:899-902. [PMID: 19183953 DOI: 10.1007/s00134-009-1406-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine prevalence and factors associated with symptoms of anxiety and depression in family members of critically ill cancer patients. DESIGN Prospective cohort study. SETTING A 23-bed intensive care unit in a tertiary cancer centre. PATIENTS AND PARTICIPANTS Three hundred consecutive families of cancer patients with length of stay >72 h in ICU. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS The Hospital Anxiety and Depression Scale questionnaire and critical care family needs inventory were completed by family members. Prevalence of anxiety and depression in family members was 71 and 50.3%, respectively. Regarding the patients' disease, family depression was correlated with presence of metastasis, whereas hematological malignancies correlated with family' anxiety. Anxiety was independently associated with one patient-related factor (prolonged mechanical ventilation) and two family-related factors (catholic religion and gender). Factors associated with symptoms of depression included one patient-related factor (presence of metastasis) and one family-related factor (gender). CONCLUSIONS Present findings demonstrated a high prevalence of anxiety and depression in critically ill cancer patients' family members during an intensive care unit stay.
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Bahadur K, Jones G, Ntoumenopoulos G. An observational study of sitting out of bed in tracheostomised patients in the intensive care unit. Physiotherapy 2008. [DOI: 10.1016/j.physio.2008.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Paul F, Rattray J. Short- and long-term impact of critical illness on relatives: literature review. J Adv Nurs 2008; 62:276-92. [PMID: 18426451 DOI: 10.1111/j.1365-2648.2007.04568.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a literature review undertaken to identify the short- and long-term impact of critical illness on relatives. BACKGROUND Patients in intensive care can experience physical and psychological consequences, and their relatives may also experience such effects. Although it is recognized that relatives have specific needs, it is not clear whether these needs are always met and whether further support is required, particularly after intensive care. DATA SOURCES The following databases were searched for the period 1950-2007: Medline, British Nursing Index and Archive, EMBASE, CINAHL, PsycINFO and EMB Reviews--Cochrane Central Register of Clinical Trials. SEARCH METHODS Search terms focused on adult relatives of critically ill adult patients during and after intensive care. Recurrent topics were categorized to structure the review, i.e. 'relatives needs', 'meeting relatives' needs', 'interventions', 'satisfaction', 'psychological outcomes' and 'coping'. RESULTS Studies have mainly identified relatives' immediate needs using the Critical Care Family Needs Inventory. There are few studies of interventions to meet relatives' needs and the short- and long-term effects of critical illness on relatives. CONCLUSION Despite widespread use of the Critical Care Family Needs Inventory, factors such as local or cultural differences may influence relatives' needs. Relatives may also have unidentified needs, and these needs should be explored. Limited research has been carried out into interventions to meet relatives' needs and the effects of critical illness on their well-being, yet some relatives may experience negative psychological consequences far beyond the acute phase of the illness.
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Affiliation(s)
- Fiona Paul
- School of Nursing and Midwifery, University of Dundee, Tayside Campus, Ninewells Hospital, Dundee, UK.
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Psychiatric illness in the next of kin of patients who die in the intensive care unit*. Crit Care Med 2008; 36:1722-8. [DOI: 10.1097/ccm.0b013e318174da72] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kirchhoff C, Stegmaier J, Buhmann S, Leidel BA, Biberthaler P, Mutschler W, Kanz KG. Trauma surgeons’ attitude towards family presence during trauma resuscitation: A nationwide survey. Resuscitation 2007; 75:267-75. [PMID: 17553609 DOI: 10.1016/j.resuscitation.2007.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 04/09/2007] [Accepted: 04/13/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Trauma is the foremost cause of death in young patients. Not only the patient but also the family experience the consequences of trauma. Interactions of medical staff with family members in the emergency situation may fail psychological and emotional needs. In this context the concept of family presence (FP) during resuscitation is controversial. Therefore, the aim of this study was to analyse the attitude of trauma surgeons towards FP during trauma resuscitation. MATERIALS AND METHODS A questionnaire concerning beliefs and attitudes towards FP during trauma resuscitation was mailed to level I trauma centres of the Trauma Network of the German Trauma Society (DGU). Statistical difference was determined by Rank-Sum test to analyse ordinal variables, for analysing three groups Kruskal-Wallis and Dunn's testing were used. Data are given in mean+/-S.D. or absolute percentage. RESULTS The questionnaire was answered by 464 of 545 (85%) trauma surgeons between July 2005 and September 2005. One hundred and sixty seven surgeons (37.9%) already knew about FP, 349 (75.2%) considered it a relevant topic, but 232 (50%) would never allow FP during trauma resuscitation. One hundred and sixty eight surgeons (36.2%) had experience of FP during trauma resuscitation with positive results in 56%. Female respondents tend to be better informed about FP and would promote FP more supportively. Those women with experience with FP reported predominantly positive experiences (87% versus 50%, p<0.001). CONCLUSIONS Our study investigated the factors affecting physicians' opinions towards FP. Any institutional FP programme will have to address physician objections to be successful, by recommending a well-designed, carefully structured protocol with a designated specially trained staff member to offer the family support and the option of entering the resuscitation room with permission of the staff.
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Affiliation(s)
- Chlodwig Kirchhoff
- Department of Orthopaedic Surgery and Traumatology, Campus Innenstadt, Ludwig-Maximilians-University, Nussbaumstrasse 20, D-80336 Munich, Germany.
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