Development and psychometric evaluation of the Relocation Stress Syndrome Scale-Short Form for patients transferred from adult intensive care units to general wards

Development of a patient-oriented transfer tool for transition from the intensive care unit to the ward: a mixed methods study

PURPOSE

The use of patient/family-centred written summaries to supplement verbal information may be useful to improve knowledge and reduce anxiety related to patient transfer from the intensive care unit (ICU) to a hospital ward. We aimed to identify essential elements to include in an ICU-specific patient-oriented discharge summary tool (PODS-ICU).

METHODS

We conducted a mixed methods study. Participants were ICU patients who were transitioning to a hospital ward and clinicians. We used a validated questionnaire to measure the relocation stress of patients, and standardized questions to qualitatively explore patients' needs during the transition, as well as perspectives of clinician stakeholders. Inductive thematic analysis was used for the qualitative analysis.

RESULTS

We recruited 22 participants, including ten patients and 12 clinician stakeholders. Of ten patients, 50-100% reported positive experiences during the transition and 10-30% reported negative experiences. From all participants' perspectives, we identified the following essential elements for the PODS-ICU: the reason for transition, a summary of the ICU course, a clinical update, destination ward details, medication reconciliation, a future care plan, and the planned follow-up by the ICU outreach team. Family presence and earlier notification of an upcoming transfer were identified as support needs to help patients prepare mentally and reduce transfer anxiety. Moreover, using positive communication with patients when providing transfer details and using the brief standardized transfer tool were recommended to improve transition care.

CONCLUSIONS

We identified informational gaps in patient and family knowledge at the time of transfer from the ICU to a ward, which informed essential elements for the PODS-ICU. The PODS-ICU may reduce transfer anxiety and improve care during the transition from the ICU.

Uncertainty experienced by the critical patient upon discharge to the general ward: Care proposals from the perspective of Mishel's theory

BACKGROUND

The process of discharging the critical patient to the ward (discharge from critical care to the general ward-DCCW) is often described as an experience involving uncertainty which may affect the patient's quality of life and ability to cope. Coping with uncertainty is an individual response not related to the course of the illness that is dependent on external and internal resources and the ability to utilize them. Mishel's theory of uncertainty identifies aspects of care that can shape the experience of uncertainty associated with the illness.

AIM

To understand the experiences of uncertainty of critical patients associated with discharge from the intensive care unit (ICU) to glean person-centred care strategies under such circumstances.

STUDY DESIGN

Qualitative study with a phenomenological approach. Between March 2017 and May 2018, 20 in-depth interviews were conducted on patients recently discharged from an ICU.

RESULTS

The patients have been organized according to the following pre-established categories of Mishel's theory: stimulus framework, structure providers and uncertainty assessment. Based on these results, suggestions for the care of the critical patient upon discharge from the ICU are made in each of these categories.

CONCLUSIONS

Applying Mishel's theoretical perspective to care for the critical patient during the process of discharge to the ward can help identify areas for intervention and improvement. To succeed, there is a need to promote a cultural change in ICUs, empower nurses and provide the necessary resources.

RELEVANCE TO CLINICAL PRACTICE

These findings are relevant and timely given the impact of the experience of critical patients discharge to the ward. Uncertainty management has been identified as an important element in the discharge experience of critically ill patients to the ward because, according to the informants' stories, it can make this transition a healthier process with less emotional impact.

Experiences of Intensive Care Unit Patients as They Transition to the Ward: A Thematic Synthesis

BACKGROUND

During the transfer of intensive care unit (ICU) patients to general wards, patients often experience transfer anxiety due to changes in the healthcare environment, staff and unfamiliarity with the new ward. However, the experiences of ICU patients during this transition period have received less attention.

AIMS

A systematic review and synthesis of the experiences of patients transitioning from the ICU to the ward.

DESIGN

Thematic synthesis of qualitative studies.

DATA SOURCES

We searched the PubMed, Embase, CINAHL and Web of Science databases for qualitative research on the transition-to-ward experience of patients in ICUs for the year 2023 February.

REVIEW METHODS

The quality of the literature was evaluated according to the qualitative research quality assessment criteria of the Joanna Briggs Institute, as outlined by the Australian Centre for Evidence-Based Healthcare. The data were then extracted from the studies, analysed and synthesised using a thematic synthesis approach.

RESULTS

A total of 12 papers were included and the 32 findings were distilled and consolidated into three themes: emotional reactions; imperfections in the transition process; differences between wards and ICUs; and eight sub-themes: optimism; pessimism; emotionlessness; inadequate information; inadequate communication; physical condition; differences in care; differences in environment.

CONCLUSIONS

The transfer from an ICU to a general ward is a major change of environment for the patient and can trigger upset and anxiety. Planning for turn-out, meeting patients' information needs and easing patients' emotions are critical in this process.

Ambient Air Pollution and Hospitalizations for Schizophrenia in China

Importance

Schizophrenia episodes may be triggered by short-term environmental stimuli. Short-term increases in ambient air pollution levels may elevate the risk of schizophrenia episodes, yet few epidemiologic studies have examined this association.

Objective

To investigate whether short-term increases in air pollution levels are associated with an additional risk of schizophrenia episodes, independent of absolute air pollution concentrations, and whether sustained increases in air pollution levels for several days are associated with more pronounced risks of schizophrenia episodes.

Design, Setting, and Participants

This nationwide, population-based, time-stratified case-crossover study was performed based on hospitalization records for schizophrenia across 295 administrative divisions of prefecture-level or above cities in China. Records were extracted from 2 major health insurance systems from January 1, 2013, to December 31, 2017. Thirty-six cities with a small number of schizophrenia hospitalizations (n < 50) were excluded. Data analysis for this study was performed from January to March 2024.

Exposure

Daily absolute concentrations of fine particulate matter (PM2.5), inhalable particulate matter (PM10), nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide were collected. Air pollution increases between neighboring days (APINs) were generated as the differences in absolute air pollution concentrations on the current day minus that on the previous day. Sustained increases (APIN ≥5 μg/m3 for PM2.5 and PM10, APIN ≥1 μg/m3 for nitrogen dioxide and sulfur dioxide, and APIN ≥0.05 mg/m3 for carbon monoxide) lasting for 1 or more to 4 or more days were defined for different air pollutants.

Main Outcome and Measure

Patients with schizophrenia episodes were identified by principal discharge diagnoses of schizophrenia. A conditional logistic regression model was used to capture the associations of absolute concentrations, APINs, and sustained increase events for different air pollutants with risks of schizophrenia hospitalizations.

Results

The study included 817 296 hospitalization records for schizophrenia across 259 Chinese cities (30.6% aged 0-39 years, 56.4% aged 40-64 years, and 13.0% aged ≥65 years; 55.04% male). After adjusting for the absolute concentrations of respective air pollutants, per-IQR increases in 6-day moving average (lag0-5) APINs of PM2.5, PM10, nitrogen dioxide, sulfur dioxide, and carbon monoxide were associated with increases of 2.37% (95% CI, 0.88%-3.88%), 2.95% (95% CI, 1.46%-4.47%), 4.61% (95% CI, 2.93%-6.32%), 2.16% (95% CI, 0.59%-3.76%), and 2.02% (95% CI, 0.39%-3.68%) in schizophrenia hospitalizations, respectively. Greater risks of schizophrenia hospitalizations were associated with sustained increases in air pollutants lasting for longer durations up to 4 or more days.

Conclusions and Relevance

This case-crossover study of the association between ambient air pollution increases and schizophrenia hospitalizations provides novel evidence that short-term increases in ambient air pollution levels were positively associated with an elevated risk of schizophrenia episodes. Future schizophrenia prevention practices should pay additional attention to APINs, especially sustained increases in air pollution levels for longer durations, besides the absolute air pollution concentrations.

Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients' Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial

OBJECTIVES

To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge.

DESIGN

A prospective, multicenter, randomized clinical trial.

SETTING

Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals.

PATIENTS

Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge.

INTERVENTION

The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward.

MEASUREMENTS AND RESULTS

Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG ( n = 91) and CG ( n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression ( p < 0.001) and the presence of depression ( p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes.

CONCLUSIONS

We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials.

TRIAL REGISTRATION

NCT04527627 ( https://clinicaltrials.gov/ct2/show/NCT04527627 ).

Development and validation of a Perceived Relocation Stress Scale for older individuals transferred to long-term care facilities in Taiwan

BACKGROUND

The aim of the current study was to develop and validate a Perceived Relocation Stress Scale.

METHODS

A cross-sectional research design was used. A total of 175 older adults residing in long-term care facilities in Southern Taiwan for at least 1 y were recruited. An exploratory factor analysis was performed to examine item convergent and discriminant validity. Concurrent validity was checked using the Depression Anxiety and Stress scale. The reliability was analyzed using Cronbach's alpha and intraclass correlation coefficients.

RESULTS

The face and content validity of the scale were verified by adequately measuring the scale items. Factor analysis consisted of four components (challenge/chance, positive appraisal, threat, loss), with a total variance of 67.35%. The content validity was determined by an expert panel to systematically examine the relevance of all items. The results of item convergent and discriminant validity supported the constructs of the scale. The alpha coefficient for the overall scale was .958, indicating good internal consistency reliability.

CONCLUSIONS

The Perceived Relocation Stress Scale is a reliable and valid measurement to assess the stress perceived by older individuals being transferred to a long-term care facility.

Parental experience of transition from a pediatric intensive care unit to a general ward: A Qualitative Study

AIM

To explore parental experience in transitioning from a pediatric intensive care unit to a general ward and to investigate parental involvement in caring for their critical illness children.

BACKGROUND

Parents have a major responsibility in caring for seriously ill children, but nursing staff fail to meet the expectations of parents regarding nursing care. Few studies have investigated the challenges and needs of Chinese parents during the transition from pediatric intensive care unit to general ward.

METHODS

Semi-structured interviews were conducted with 24 parents of children with critical illness in a pediatric hospital in Shanghai, mainland China to explore their views. Transcripts were entered into NVivo. Framework analysis was used to analyze the qualitative data.

RESULTS

Four themes were identified by data analysis: changes in the child during post pediatric intensive care unit periods; experiencing a wide range of emotions; factors involved in the transition; and suggestions for improving transitional care.

CONCLUSIONS

Due to the unmet needs of parents, a more flexible visiting policy and social media support were highly desirable. Getting accurate information, establishing family integrated care, and strengthening ward-based critical support services were also listed as important needs of parents caring for critically ill children.

IMPLICATIONS FOR NURSING MANAGEMENT

A profound understanding of parental experiences during the transitional period can help nursing staff to assess the effects on children and their families, improve ward-based intensive care, support parental participation, and improve visitation policies. Based on these findings, nurse managers can develop reasonable intervention programs in order to improve nursing quality and patient outcomes.

Patients' experience while transitioning from the intensive care unit to a ward

BACKGROUND

Intensive care unit (ICU) patients can experience emotional distress and post-traumatic stress disorder when they leave the ICU, also referred to as post-intensive care syndrome. A deeper understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient-centred care and, ultimately, contribute to a positive experience.

AIM

To describe the patients' experience while transitioning from the ICU to a general ward.

DESIGN

A descriptive qualitative study.

METHOD

Data were gathered through in-depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.

FINDINGS

Forty-eight interviews were conducted. Impact on emotional well-being emerged as a main theme, comprising four categories with six subcategories.

CONCLUSION

Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well-being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward.

RELEVANCE TO CLINICAL PRACTICE

It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow-up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge.

Mixed-method research protocol: Development and evaluation of a nursing intervention in patients discharged from the intensive care unit

AIM

(a) To understand patients' lived experience at intensive care unit (ICU) discharge and (b) to evaluate the impact of a nursing empowerment intervention (NEI) on patients' anxiety and depression levels at ICU discharge.

DESIGN

A mixed-methods approach will be applied.

METHODS

In the qualitative phase, the hermeneutic phenomenological method will be used. Participants will be patients from three university hospitals who will be selected by purposive sampling. Data will be gathered through in-depth interviews and analysed using content analysis. The qualitative data obtained will be employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group will be used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale (HADS). Simple random probabilistic sampling will include 172 patients in this phase.