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Pant U, Vyas K, Meghani S, Park T, Norris CM, Papathanassoglou E. Screening tools for post-intensive care syndrome and post-traumatic symptoms in intensive care unit survivors: A scoping review. Aust Crit Care 2023; 36:863-871. [PMID: 36464526 DOI: 10.1016/j.aucc.2022.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post-intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life. OBJECTIVES We aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies. METHOD A scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines. FINDINGS We identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools. CONCLUSION These results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge.
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Affiliation(s)
- Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Krooti Vyas
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Shaista Meghani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Tanya Park
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Colleen M Norris
- Professor, Faculty of Nursing, Scientific Director, Cardiovascular Health and Stroke Strategic Clinical Network, Adjunct Professor Faculty of Medicine & Dentistry and School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Elizabeth Papathanassoglou
- Professor, Faculty of Nursing, University of Alberta, Scientific Director, Neurosciences Rehabilitation & Vision Strategic Clinical Network™ Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada.
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Ringdal M, Bergbom I, Nilsson J, Karlsson V. Older patients' recovery following intensive care: A follow-up study with the RAIN questionnaire. Intensive Crit Care Nurs 2021; 65:103038. [PMID: 33775549 DOI: 10.1016/j.iccn.2021.103038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
The aim was to investigate older patient recovery (65 years+) up to two years following discharge from an intensive care unit (ICU) using the Recovery After Intensive Care (RAIN) instrument and to correlate RAIN with the Hospital Anxiety and Depression Scale (HAD). METHODS An explorative and descriptive longitudinal design was used. Eighty-two patients answered RAIN and HAD at least twice following discharge. Demographic and clinical data were collected from patient records. RESULTS Recovery after the ICU was relatively stable and good for older patients at the four data collection points. There was little variation on the RAIN subscales over time. The greatest recovery improvement was found in existential ruminations from 2 to 24 months. A patient that could look forward and those with supportive relatives had the highest scores at all four measurements. Having lower financial situation was correlated to poorer recovery and was significant at 24 months. The RAIN and HAD instruments showed significant correlations, except for the revaluation of life subscale, which is not an aspect in HAD. CONCLUSION The RAIN instrument shows to be a good measurement for all dimensions of recovery, including existential dimensions, which are not covered by any other instrument.
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Affiliation(s)
- M Ringdal
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Kungälvs Hospital, Sweden.
| | - I Bergbom
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Sweden, Professor Emerita, Honorary Doctor at Åbo Academy, Åbo, Finland
| | - J Nilsson
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Sweden
| | - V Karlsson
- Department of Health Science, University West, Trollhättan, Sweden
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King J, O’Neill B, Ramsay P, Linden MA, Darweish Medniuk A, Outtrim J, Blackwood B. Identifying patients' support needs following critical illness: a scoping review of the qualitative literature. Crit Care 2019; 23:187. [PMID: 31126335 PMCID: PMC6533750 DOI: 10.1186/s13054-019-2441-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting recovery is an international priority. As survivors' transition from the intensive care unit to home, their support needs develop and change. METHODS In this scoping review, we categorised patients' support needs using House's Social Support Needs framework (informational, emotional, instrumental, appraisal) and mapped these against the Timing it Right framework reflecting the patient's transition from intensive care (event/diagnosis) to ward (stabilisation/preparation) and discharge home (implementation/adaptation). We searched electronic databases from 2000 to 2017 for qualitative research studies reporting adult critical care survivors' experiences of care. Two reviewers independently screened, extracted and coded data. Data were analysed using a thematic framework approach. RESULTS From 3035 references, we included 32 studies involving 702 patients. Studies were conducted in UK and Europe (n = 17, 53%), Canada and the USA (n = 6, 19%), Australasia (n = 6, 19%), Hong Kong (n = 1, 3%), Jordan (n = 1, 3%) and multi-country (n = 1, 3%). Across the recovery trajectory, informational, emotional, instrumental, appraisal and spiritual support needs were evident, and the nature and intensity of need differed when mapped against the Timing it Right framework. Informational needs changed from needing basic facts about admission, to detail about progress and treatments and coping with long-term sequelae. The nature of emotional needs changed from needing to cope with confusion, anxiety and comfort, to a need for security and family presence, coping with flashbacks, and needing counselling and community support. Early instrumental needs ranged from managing sleep, fatigue, pain and needing nursing care and transitioned to needing physical and cognitive ability support, strength training and personal hygiene; and at home, regaining independence, strength and return to work. Appraisal needs related to obtaining feedback on progress, and after discharge, needing reassurance from others who had been through the ICU experience. CONCLUSIONS This review is the first to identify the change in social support needs among intensive care survivors as they transition from intensive care to the home environment. An understanding of needs at different transition periods would help inform health service provision and support for survivors.
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Affiliation(s)
- J. King
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - B. O’Neill
- Centre for Health and Rehabilitation Technologies, INHR, Ulster University, Newtownabbey, Northern Ireland, UK
| | - P. Ramsay
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - M. A. Linden
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - A. Darweish Medniuk
- Department of Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - J. Outtrim
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, England, UK
| | - B. Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
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Reid JC, Clarke F, Cook DJ, Molloy A, Rudkowski JC, Stratford P, Kho ME. Feasibility, Reliability, Responsiveness, and Validity of the Patient-Reported Functional Scale for the Intensive Care Unit: A Pilot Study. J Intensive Care Med 2019; 35:1396-1404. [PMID: 30669936 DOI: 10.1177/0885066618824534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although many performance-based measures assess patients' physical function in intensive care unit (ICU) survivors, to our knowledge, there are no patient-reported ICU rehabilitation-specific measures assessing function. We developed the Patient-Reported Functional Scale-ICU (PRFS-ICU), which measures patients' perceptions of their ability to perform 6 activities (rolling, sitting edge of bed, sit-to-stand and bed-to-chair transfers, ambulation, and stair climbing). Each item is scored from 0 (unable) to 10 (able to perform at pre-ICU level) to a maximum of 60. OBJECTIVES Estimate the feasibility, reliability, responsiveness, and validity of the PRFS-ICU. METHODS This was a substudy of TryCYCLE, a single-center, prospective cohort examining the safety and feasibility of early in-bed cycling with mechanically ventilated patients (NCT01885442). To determine feasibility, we calculated the number of patients with at least 1 PRFS-ICU assessment during their hospital stay. To assess reliability, 2 raters blinded to each other's assessments administered the PRFS-ICU within 24-hours of each other. We calculated the intraclass correlation coefficient (ICC; 95% confidence interval [CI]), standard error of measurement (SEM, 95% CI), and minimal detectable change (MDC90). To assess validity, we estimated convergent validity of the PRFS-ICU with the Functional Status Score for ICU (FSS-ICU), Medical Research Council Sum Score (MRC-SS), Physical Function Test for ICU (PFIT-s), Katz Index of Independence in Activities of Daily Living (Katz ADLs), and a pooled index using Pearson's correlation coefficient (r, 95% CI). RESULTS Feasibility: 20 patients completed a PRFS-ICU assessment. Reliability and responsiveness: 16 patients contributed data. The ICC, SEM, and MDC90 were 0.91 (0.76, 0.97), 4.75 (3.51, 7.35), and 11.04 points, respectively. Validity: 19 patients contributed data and correlations were (r [95% CI]): FSS-ICU (0.40 [-0.14, 0.76]), MRC-SS (0.51 [0.02, 0.80]), PFIT-s (0.43 [-0.13, 0.78]), Katz ADLs (0.53 [0.10, 0.79]), and pooled index (0.48 [-0.14, 0.82]). CONCLUSIONS Our pilot work suggests the PRFS-ICU may be a useful tool to assess and monitor patients' perceptions of function over time.
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Affiliation(s)
- Julie C Reid
- Faculty of Health Sciences, School of Rehabilitation Science, 3710McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada
| | - France Clarke
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, McMaster University Medical Center, Hamilton, Ontario, Canada.,Department of Medicine, 62703McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
| | - Alexander Molloy
- Department of Physiotherapy, 25479St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jill C Rudkowski
- Department of Medicine, 62703McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
| | - Paul Stratford
- Faculty of Health Sciences, School of Rehabilitation Science, 3710McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada
| | - Michelle E Kho
- Faculty of Health Sciences, School of Rehabilitation Science, 3710McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada.,Department of Physiotherapy, 25479St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Åkerman E, Langius-Eklöf A. The impact of follow-up visits and diaries on patient outcome after discharge from intensive care: A descriptive and explorative study. Intensive Crit Care Nurs 2018; 49:14-20. [PMID: 30241979 DOI: 10.1016/j.iccn.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To explore the possible effects of intensive care follow-up visits and diaries on patients physical and psychosocial problems at 2, 6, and 12 months after unit discharge as well as the patient' experiences of follow-up visits and diaries. METHODS A descriptive and explorative cohort design. Patients (n = 441) with a length of ICU stay for ≥24 hours, who responded to the 3-set 4P questionnaire were included. Patients were divided into groups depending on when they responded to the questionnaire and if had or had not a follow-up visit or a diary. RESULTS Patients found the follow-up visit and the diary valuable and helpful during the recovery. In the univariate general linear model analyses, the follow-up group reported more problems in Mood and Memory. Longer length of stay was a predictor for unfavourable scoring in the domains Change in Appearance and Memory and for favourable scoring in the domain Social Life. The diary group reported more problems in Change in Appearance, Mood, and Memory and fewer problems in Social Life. CONCLUSION No strong effects of follow-up or diary on patient outcomes were seen. However, because the patients experienced that the interventions had helped them during recovery, further exploration of the matter is needed in the process of testing these interventions.
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Affiliation(s)
- Eva Åkerman
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 52 Stockholm, Sweden; General Intensive Care Unit, Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 141 86 Stockholm, Sweden.
| | - Ann Langius-Eklöf
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 52 Stockholm, Sweden
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Bergbom I, Karlsson V, Ringdal M. Developing and evaluating an instrument to measure Recovery After INtensive care: the RAIN instrument. BMC Nurs 2018; 17:5. [PMID: 29456456 PMCID: PMC5809841 DOI: 10.1186/s12912-018-0275-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background Measuring and evaluating patients' recovery, following intensive care, is essential for assessing their recovery process. By using a questionnaire, which includes spiritual and existential aspects, possibilities for identifying appropriate nursing care activities may be facilitated. The study describes the development and evaluation of a recovery questionnaire and its validity and reliability. Methods A questionnaire consisting of 30 items on a 5-point Likert scale was completed by 169 patients (103 men, 66 women), 18 years or older (m=69, SD 12.5) at 2, 6, 12 or 24 months following discharge from an ICU. An exploratory factor analysis, including a principal component analysis with orthogonal varimax rotation, was conducted. Ten initial items, with loadings below 0.40, were removed. The internal item/scale structure obtained in the principal component analysis was tested in relation to convergent and discrimination validity with a multi-trait analysis. Items consistency and reliability were assessed by Cronbach's alpha and internal item consistency. Test of scale quality, the proportion of missing values and respondents' scoring at maximum and minimum levels were also conducted. Results A total of 20 items in six factors - forward looking, supporting relations, existential ruminations, revaluation of life, physical and mental strength and need of social support were extracted with eigen values above one. Together, they explained 75% of the variance. The half-scale criterion showed that the proportion of incomplete scale scores ranged from 0% to 4.3%. When testing the scale's ability to differentiate between levels of the assessed concept, we found that the observed range of scale scores covered the theoretical range. Substantial proportions of respondents, who scored at the ceiling for forward looking and supporting relations and at floor for the need of social support, were found. These findings should be further investigated. Conclusion The factor analysis, including discriminant validity and the mean value for the item correlations, was found to be excellent. The RAIN instrument could be used to assess recovery following intensive care. It could provide post-ICU clinics and community/primary healthcare nurses with valuable information on which areas patients may need more support.
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Affiliation(s)
- Ingegerd Bergbom
- 1Institute of Health and Care Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,2Faculty of Caring Science, Work Life and Social Welfare, Borås University, Borås, Sweden
| | - Veronika Karlsson
- 3Department of Health Sciences, University West, Trollhättan, Sweden
| | - Mona Ringdal
- 1Institute of Health and Care Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anesthetic and Intensive Care, Kungälvs hospital, Kungälv, Sweden
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Robinson KA, Davis WE, Dinglas VD, Mendez-Tellez PA, Rabiee A, Sukrithan V, Yalamanchilli R, Turnbull AE, Needham DM. A systematic review finds limited data on measurement properties of instruments measuring outcomes in adult intensive care unit survivors. J Clin Epidemiol 2016; 82:37-46. [PMID: 27865899 DOI: 10.1016/j.jclinepi.2016.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 07/18/2016] [Accepted: 08/09/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE There is a growing number of studies evaluating the physical, cognitive, mental health, and health-related quality of life (HRQOL) outcomes of adults surviving critical illness. However, there is little consensus on the most appropriate instruments to measure these outcomes. To inform the development of such consensus, we conducted a systematic review of the performance characteristics of instruments measuring physical, cognitive, mental health, and HRQOL outcomes in adult intensive care unit (ICU) survivors. METHODS We searched PubMed, Embase, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and The Cochrane Library in March 2015. We also conducted manual searches of reference lists of eligible studies and relevant review articles. Two people independently selected studies, completed data abstraction, and assessed the quality of eligible studies using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) initiative checklist. RESULTS We identified 20 studies which explicitly evaluated measurement properties for 21 different instruments assessing outcomes in ICU survivors. Eleven of the instruments assessed quality of life, with few instruments assessing other domains. Of the nine measurement properties evaluated on the COSMIN checklist, six were assessed in <10% of the evaluations. Overall quality of eligible studies was generally poor to fair based on the COSMIN checklist. CONCLUSIONS Although an increasing number of studies measure physical, cognitive, mental health, and HRQOL outcomes in adult ICU survivors, data on the measurement properties of such instruments are sparse and generally of poor to fair quality. Empirical analyses evaluating the performance of instruments in adult ICU survivors are needed to advance research in this field.
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Affiliation(s)
- Karen A Robinson
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA.
| | - Wesley E Davis
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Pedro A Mendez-Tellez
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Anahita Rabiee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Vineeth Sukrithan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Ramakrishna Yalamanchilli
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Alison E Turnbull
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21287, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Lim WC, Black N, Lamping D, Rowan K, Mays N. Conceptualizing and measuring health-related quality of life in critical care. J Crit Care 2016; 31:183-93. [DOI: 10.1016/j.jcrc.2015.10.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/30/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023]
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Akerman E, Fridlund B, Samuelson K, Baigi A, Ersson A. Psychometric evaluation of 3-set 4P questionnaire. Intensive Crit Care Nurs 2012; 29:40-7. [PMID: 22835992 DOI: 10.1016/j.iccn.2012.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 06/11/2012] [Accepted: 06/16/2012] [Indexed: 11/24/2022]
Abstract
This is a further development of a specific questionnaire, the 3-set 4P, to be used for measuring former ICU patients' physical and psychosocial problems after intensive care and the need for follow-up. The aim was to psychometrically test and evaluate the 3-set 4P questionnaire in a larger population. The questionnaire consists of three sets: "physical", "psychosocial" and "follow-up". The questionnaires were sent by mail to all patients with more than 24-hour length of stay on four ICUs in Sweden. Construct validity was measured with exploratory factor analysis with Varimax rotation. This resulted in three factors for the "physical set", five factors for the "psychosocial set" and four factors for the "follow-up set" with strong factor loadings and a total explained variance of 62-77.5%. Thirteen questions in the SF-36 were used for concurrent validity showing Spearman's r(s) 0.3-0.6 in eight questions and less than 0.2 in five. Test-retest was used for stability reliability. In set follow-up the correlation was strong to moderate and in physical and psychosocial sets the correlations were moderate to fair. This may have been because the physical and psychosocial status changed rapidly during the test period. All three sets had good homogeneity. In conclusion, the 3-set 4P showed overall acceptable results, but it has to be further modified in different cultures before being considered a fully operational instrument for use in clinical practice.
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Affiliation(s)
- Eva Akerman
- School of Health Sciences, Jönköping University, Jönköping, Sweden.
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Akerman E, Granberg-Axéll A, Ersson A, Fridlund B, Bergbom I. Use and practice of patient diaries in Swedish intensive care units: a national survey. Nurs Crit Care 2010; 15:26-33. [PMID: 20070812 DOI: 10.1111/j.1478-5153.2009.00364.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe and compare the extent and application of patients' diaries in Sweden. BACKGROUND Since 1991, patient diaries have been used in intensive care unit (ICU) follow-up in Sweden. There is paucity of relevant data evaluating the effect of this tool and also on what premises patients are enrolled. Likewise, data are sparse on the diaries' design, content structure and the use of photographs. DESIGN Descriptive explorative design by a semi-structured telephone interview. METHODS The interview results were analysed with descriptive statistics and differences between the ICU levels were explored by chi(2) analysis. Qualitative manifest content analysis was performed to explore the purpose of diary writing. RESULTS Of all ICUs (n = 85), 99% responded and 75% used diaries. The source of inspiration was collegial rather than from scientific data. The main reason for keeping a diary was to help the patient to recapitulate the ICU stay. Discrepancies between the different levels of ICUs were detected in patient selection, dedicated staff for follow-up and the use of photographs. Comparison between the chi(2) analysis and the content analysis outcome displayed incongruence between the set unit-goals and the activities for achievement but did not explain the procedural differences detected. CONCLUSION The uses of diaries in post ICU follow up were found to be common in Sweden. A majority used defined goals and content structure. However, there were differences in practice and patient recruitment among the levels of ICUs. These discrepancies seemed not to be based on evidence-based data nor on ongoing research or evaluation but merely on professional judgement. As ICU follow-up is resource intense and time consuming, it is paramount that solid criteria for patient selection and guidelines for the structure and use of diaries in post-ICU follow-up are defined.
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Affiliation(s)
- Eva Akerman
- Department of Intensive Care Medicine, Malmö University Hospital, 205 02 Malmö, Sweden.
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