Stressors in the ICU: a comparison of patients' and nurses' perceptions

Changes in Physiological Indices Before and After Nursing Care of Postoperative Patients With Esophageal Cancer in the ICU

Introduction

Various stressors have been identified in patients in the intensive care unit (ICU), including postoperative pain, ventilatory management, and nursing care. However, sedated patients are less responsive, and nurses have difficulty capturing their stressors.

Objective

To investigate patient stress caused by nursing care performed in the ICU on sedated patients based on changes in physiological indices.

Methods

We observed nursing care performed on patients with postoperative esophageal cancer under sedation in the ICU. This included endotracheal suctioning and turning, the time required for the care, and the patients' behavioral responses. Information on arousal levels, autonomic nervous system indices, and vital signs were also obtained. The changes in indicators before and after care were then compared and analyzed.

Results

There were 14 patients in the study. The mean age of the patients was 68 years. Ninety-nine scenes of nursing care were observed, and in six of these, additional bolus sedation was administered because of the patient's significant body movements. In endotracheal suctioning, no significant changes were observed in all indicators. In turning, vital signs changed significantly, and when both were continued, all indicators changed significantly.

Conclusion

Our study found that different types and combinations of nursing care may cause different stresses to the patients. Moreover, the autonomic nervous system indices may be more likely to react to stresses in a variety of nursing care, while arousal levels may be more likely to react to burdensome stresses. If the characteristics of these physiological indicators can be understood and effectively utilized during care, it may be possible to better identify and reduce patient stress during sedation management.

What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and metasynthesis

PURPOSE

Tracheostomy is a common surgical procedure in ICU. Whilst often life-saving, it can have important impacts on patients. Much of the literature on tracheostomy focuses on timing and technique of insertion, risk factors and complications. More knowledge of patient experience of tracheostomy in ICU is needed to support person-centred care.

MATERIALS AND METHODS

Qualitative systematic review and metasynthesis of the literature on adult experience of tracheostomy in ICU. Comprehensive search of four bibliographic databases and grey literature. Title and abstract screening and full text eligibility was completed independently by two reviewers. Metasynthesis was achieved using thematic synthesis, supported by a conceptual framework of humanised care.

RESULTS

2971 search returns were screened on title and abstract and 127 full texts assessed for eligibility. Thirteen articles were included for analysis. Five descriptive and three analytical themes were revealed. The over-arching theme was 'To be seen and heard as a whole person'. Patients wanted to be treated as a human, and having a voice made this easier.

CONCLUSIONS

Voice restoration should be given high priority in the management of adults with a tracheostomy in ICU. Staff training should focus on both technical skills and compassionate care to improve person-centred outcomes.

Provider’s Perception of Parental Anxiety in the Pediatric Intensive Unit

Parents of critically ill children in the Pediatric Intensive Care Unit (PICU) commonly experience new or worsening anxiety, which can lead to long-term sequelae in the form of post-traumatic stress disorder (PTSD). To investigate how well the PICU providers recognize and assess parental anxiety, we assessed the acute and baseline anxiety level of 30 parents in the PICU with the State-Trait Anxiety Inventory (STAI) and compared the results with the PICU physician's and nurses' assessments. All but four parents experienced higher acute anxiety scores compared to baseline, with a 34% increase in the number of parents with moderate and high anxiety scores. All PICU providers performed poorly in recognizing and assessing parental anxiety, with a tendency to underestimate the level of anxiety. Proper screening tools and strategies are essential to recognize and help parents in distress and potentially prevent long-term psychological sequelae.

Perceived Severity of Stressors in the Intensive Care Unit: A Systematic Review and Semi-Quantitative Analysis of the Literature on the Perspectives of Patients, Health Care Providers and Relatives

The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from 1989 to 15 May 2020. Data were analyzed with descriptive and semi-quantitative methods to yield summarizing ranking lists of the most severe stressors. We synthesized the results of 42 prospective cross-sectional observational studies from different international regions. All investigations had assessed patient ratings. Thirteen studies also measured HCP ratings, and four studies included ratings of relatives. Data indicated that patients rate the severity of stressors lower than HCPs and relatives do. Out of all ranking lists, we extracted 137 stressor items that were most frequently ranked among the most severe stressors. After allocation to four domains, a group of clinical ICU experts sorted these stressors with good to excellent agreement according to their stress levels. Our results may contribute to improve HCPs' and relatives' understanding of patients' perceptions of stressors in the ICU. The synthesized stressor rankings can be used for the development of new assessment instruments of stressors.

Stressors in intensive cardiac care units: Patients' perceptions

BACKGROUND

Patients with acute coronary syndrome (ACS) are often admitted to intensive cardiac care units (ICCUs) to have their vital signs and ventricular function monitored. In most cases, they are conscious and bedbound, causing high stress and anxiety levels.

AIMS AND OBJECTIVES

To assess the stressors affecting patients admitted to ICCUs.

DESIGN

This is a cross-sectional study performed in a public hospital in São Paulo, Brazil.

METHODS

A sample of 100 patients with ACS admitted to an ICCU, after 24 hours of hospitalization, was recruited. Sociodemographic and clinical data were collected, and the Intensive Care Unit Stressor Assessment Scale (ICESS) was applied to investigate stressors. The ICESS' internal consistency was estimated by Cronbach's alpha, and the stressors were analysed by descriptive statistics, association tests, and correlation tests.

RESULTS

Most patients were male, married, and aged 51 to 60 years. The ICESS showed an excellent internal consistency. The mean score identified in patients pointed to a non-stressed to moderately stressed condition. The indicators considered to be more stressful were as follows: "Not knowing ICU length of stay," "Being unable to fulfil family roles," "Missing husband or wife," and "Loss of self-control."

CONCLUSIONS

Stress levels were considered to be non-stressful to moderately stressful. The main stressors were related to psychological distress and physical discomfort dimensions.

RELEVANCE TO CLINICAL PRACTICE

Mapping the main stressors of patients with coronary artery disease will allow health professionals to implement strategies to reduce them and consequently reduce their anxiety levels.

Psychometric evaluation of the Hospitalisation-Related Stressors Questionnaire for Elderly Patients

BACKGROUND

Stress can threaten the health and recovery of patients, and determining the level of stress can be an important factor in curing illnesses. The aim was to adapt the Hospitalisation-Related Stressors Questionnaire for Elderly Patients (HRSQ-EP) and perform its psychometric evaluation.

METHODS

In the study, the method of developing a scale and determining the construct validity and reliability of this scale was used. The research was carried out with elderly patients who were hospitalised. The research was conducted in two main phases; in the first phase, after providing expert opinion for the language validity of the scale, the content and face validity were confirmed and then confirmatory and exploratory factor analyses were applied for content validity and reliability in the second phase.

RESULTS

The new scale, which was formed as a result of evaluating the construct validity, consisted of three factors and 15 items, and all factors explained 67.1% of the total variance. Kaiser-Meyer-Olkin, which determined the suitability of the measurement tool for factor analysis, was determined as 0.901 and Bartlett test 0.000. The adapted short form is a simple and easy-to-understand tool for determining the stress levels of hospitalised elderly individuals. HRSQ-EP provided evidence that it demonstrates adequate internal consistency, reliability and construct validity.

CONCLUSION

The results suggested that the adapted measurement tool will be useful. The scale is recommended to be evaluated in different populations to determine cultural differences.

Tools for assessment of acute psychological distress in critical illness: A scoping review

OBJECTIVES

Patients' experience of psychological distress in the intensive care unit (ICU) is associated with adverse effects, reduced satisfaction, and delayed physical and psychological recovery. There are no specific guidelines for the assessment and management of acute psychological distress during hospitalisation in the ICU. We reviewed existing tools for the assessment of acute psychological distress in ICU patients, examined evidence on their metric properties, and identified potential gaps and methodological considerations.

METHOD

A scoping review based on literature searches (Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted as per current scoping review guidelines.

FINDINGS

Overall, 14 assessment tools were identified having been developed in diverse ICU settings. The identified tools assess mainly anxiety and depressive symptoms and ICU stressors, and investigators have reported various validity and reliability metrics. It was unclear whether available tools can be used in specific groups, such as noncommunicative patients and patients with delirium, brain trauma, stroke, sedation, and cognitive impairments.

CONCLUSION

Available tools have methodological limitations worth considering in future investigations. Given the high prevalence of psychiatric morbidity in ICU survivors, rigorously exploring the metric integrity of available tools used for anxiety, depressive, and psychological distress symptom assessment in the vulnerable ICU population is a practice and research priority.

RELEVANCE TO CLINICAL PRACTICE

These results have implications for the selection and implementation of psychological distress assessment methods as a means for promoting meaningful patient-centred clinical outcomes and humanising ICU care experiences.

The impact of health literacy environment on patient stress: a systematic review

Background

There exists little literature on situational health literacy - that is, how an individual’s health literacy varies across different health literacy environments. However, one can consider the role of stress when examining the relationship between health situations and decision-making ability, and by proxy health literacy. The aim of this study was to assess the strength of the evidence on the relationship between health situations and patient stress, considered in the context of health professional perception, and determine what health situations act to influence patient stress.

Methods

A systematic review of English articles using PubMed, PsycINFO, CINAHL and Embase databases was conducted. Search terms focused on ‘patient’, ‘stress’, and ‘health care situations’. Only peer-reviewed original research with data on patient stress in the context of a health facility environment was included. Studies were screened and critically appraised by both authors. Study elements for extraction were defined by RO and extracted by JY.

Results

Twenty-four studies were included for narrative synthesis. Patients in Intensive Care Units were more stressed about factors relating to their physical discomfort, with some agreement from health care professionals. Parents of children in Intensive Care Units were more concerned with stressors relating to their child’s appearance and behaviour, and alteration in their parental role. Few studies examined health settings other than Intensive Care Units, and those that did varied greatly in terms of study design and population characteristics, lacking generalisability.

Conclusions

Overall, the findings of what patients find most stressful in Intensive Care Units can guide health care professionals practicing best practice care. However, the evidence on how patient stress is influenced by non-Intensive Care Unit health care settings is weak. Further research is needed to enhance current understanding of the interaction between patient stress and health care environments in both hospital and primary care settings.

Estimation of critically ill patients' complaints by the nurse, the physician and the patient's family: A prospective comparative study

OBJECTIVES

To evaluate the ability of the families of critically ill patients and of the intensive care team caring for the patient to communicate and accurately identify patients' complaints.

DESIGN

The complaints of critically ill patients were evaluated by a psychologist using a list of 12 items. The same day as the patient interview, the psychologist collected an estimation of the patient's complaints from the family, the nurse and the physician.

SETTING

20-bed Intensive Care Unit in a large University Hospital.

MAIN OUTCOME MEASURES

Patients' complaints.

RESULTS

51 patients were included. The most frequently reported complaints were insomnia, the inability to talk and presence of a tracheal tube. Patients reported a significantly higher prevalence of "misunderstanding" than that estimated by the nurses (55% vs 33%, p=0.045). The reported prevalence of "inability to talk" as the main complaint was significantly higher among patients than estimated by nurses and physicians (16% vs 2%, p=0.03 and 16% vs 2%, p=0.03 respectively). For the analysis of the individual complaints, there was a poor agreement between the patients and the other respondents.

CONCLUSION

This study found that the estimation of critically ill patients' complaints by their families, nurses and physicians was largely suboptimal.

Thank you letters from patients in an intensive care unit: From the expression of gratitude to an applied ethic of care

INTRODUCTION

Patients' perception of an intensive care unit stay can lead to a better understanding of the expectations and needs of patients hospitalised in intensive care so that care for critically ill patients can be adapted and improved. Thank you letters are sources of original information which come directly and spontaneously from patients.

OBJECTIVE

The objective of this study was to analyse the thank you letters from patients who required intensive care treatment and to identify messages that could be intended for the intensive care unit team.

DESIGN

We conducted a qualitative study according to a thematic analysis. The body of research consisted of 17 letters from patients hospitalised in intensive care unit.

SETTING

The study took place in the medical-surgical intensive care unit of a French general hospital. The intensive care unit is made up of 16 resuscitation beds and four continuous monitoring beds.

FINDINGS

Two main themes emerged: (i) expression of gratitude through a description of the caregivers' behaviour (humanity and professionalism) and recognition for surviving (ii) the narrative of the intensive care unit experience.

CONCLUSION

Thank you letters give a rich insight into how the patients perceived their stay in intensive care unit. Letters from patients give direct feedback on the quality of care provided, contribute to give meaning to work and raise the question of what the core values of care should be for all concerned in the healthcare providers-patients relationship.

Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review

BACKGROUND

Care of critically ill patients in intensive care units (ICUs) often requires potentially invasive or uncomfortable procedures, such as mechanical ventilation (MV). Sedation can alleviate pain and discomfort, provide protection from stressful or harmful events, prevent anxiety and promote sleep. Various sedative agents are available for use in ICUs. In the UK, the most commonly used sedatives are propofol (Diprivan(®), AstraZeneca), benzodiazepines [e.g. midazolam (Hypnovel(®), Roche) and lorazepam (Ativan(®), Pfizer)] and alpha-2 adrenergic receptor agonists [e.g. dexmedetomidine (Dexdor(®), Orion Corporation) and clonidine (Catapres(®), Boehringer Ingelheim)]. Sedative agents vary in onset/duration of effects and in their side effects. The pattern of sedation of alpha-2 agonists is quite different from that of other sedatives in that patients can be aroused readily and their cognitive performance on psychometric tests is usually preserved. Moreover, respiratory depression is less frequent after alpha-2 agonists than after other sedative agents.

OBJECTIVES

To conduct a systematic review to evaluate the comparative effects of alpha-2 agonists (dexmedetomidine and clonidine) and propofol or benzodiazepines (midazolam and lorazepam) in mechanically ventilated adults admitted to ICUs.

DATA SOURCES

We searched major electronic databases (e.g. MEDLINE without revisions, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE and Cochrane Central Register of Controlled Trials) from 1999 to 2014.

METHODS

Evidence was considered from randomised controlled trials (RCTs) comparing dexmedetomidine with clonidine or dexmedetomidine or clonidine with propofol or benzodiazepines such as midazolam, lorazepam and diazepam (Diazemuls(®), Actavis UK Limited). Primary outcomes included mortality, duration of MV, length of ICU stay and adverse events. One reviewer extracted data and assessed the risk of bias of included trials. A second reviewer cross-checked all the data extracted. Random-effects meta-analyses were used for data synthesis.

RESULTS

Eighteen RCTs (2489 adult patients) were included. One trial at unclear risk of bias compared dexmedetomidine with clonidine and found that target sedation was achieved in a higher number of patients treated with dexmedetomidine with lesser need for additional sedation. The remaining 17 trials compared dexmedetomidine with propofol or benzodiazepines (midazolam or lorazepam). Trials varied considerably with regard to clinical population, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded outcome assessors. Compared with propofol or benzodiazepines (midazolam or lorazepam), dexmedetomidine had no significant effects on mortality [risk ratio (RR) 1.03, 95% confidence interval (CI) 0.85 to 1.24, I (2) = 0%; p = 0.78]. Length of ICU stay (mean difference -1.26 days, 95% CI -1.96 to -0.55 days, I (2) = 31%; p = 0.0004) and time to extubation (mean difference -1.85 days, 95% CI -2.61 to -1.09 days, I (2) = 0%; p < 0.00001) were significantly shorter among patients who received dexmedetomidine. No difference in time to target sedation range was observed between sedative interventions (I (2) = 0%; p = 0.14). Dexmedetomidine was associated with a higher risk of bradycardia (RR 1.88, 95% CI 1.28 to 2.77, I (2) = 46%; p = 0.001).

LIMITATIONS

Trials varied considerably with regard to participants, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded assessors.

CONCLUSIONS

Evidence on the use of clonidine in ICUs is very limited. Dexmedetomidine may be effective in reducing ICU length of stay and time to extubation in critically ill ICU patients. Risk of bradycardia but not of overall mortality is higher among patients treated with dexmedetomidine. Well-designed RCTs are needed to assess the use of clonidine in ICUs and identify subgroups of patients that are more likely to benefit from the use of dexmedetomidine.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42014014101.

FUNDING

The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Cuidado y manejo del dolor en el paciente en posoperatorio de revascularización miocárdica

<p>En la actualidad, se ha puesto de manifiesto la relación existente entre el dolor agudo posoperatorio y la aparición de múltiples complicaciones, que hacen necesario el manejo efectivo del dolor posquirúrgico por parte del profesional de enfermería. Objetivo: Generar una propuesta de cuidado de enfermería para el manejo del dolor en el paciente en posoperatorio de revascularización miocárdica, tras la extubación, con base en la Teoría de los Síntomas Desagradables. Metodología: A partir de la metodología del marco lógico, se socializó la importancia del manejo del dolor en el paciente en posoperatorio de revascularización miocárdica, así como la Teoría de los Síntomas Desagradables, al personal de enfermería que labora en una Unidad de Cuidado Intensivo de una Institución Prestadora de Servicios de Salud de IV Nivel en la ciudad de Bogotá. Se elaboró un formato de valoración para establecer los factores que determinaban el dolor, las características del síntoma dolor y las consecuencias del síntoma, para luego establecer la propuesta de cuidado de enfermería. Resultados: Se valoró la experiencia del dolor en nueve pacientes en posoperatorio de revascularización miocárdica, obteniendo como hallazgo que la presencia del dolor, principalmente, impedía la actividad física, la tos efectiva y el sueño, ocasionando un alto nivel de ansiedad, preocupación y cansancio. Con base en los hallazgos, se proponen ocho diagnósticos de enfermería, con sus respectivas actividades. Conclusión: La adecuada valoración y manejo del dolor postquirúrgico por parte del profesional de enfermería permite una recuperación adecuada, así como un aumento del bienestar y la comodidad en el paciente revascularizado.</p>

Development and initial psychometric evaluation of the hospitalization-related stressors questionnaire for elderly patients

BACKGROUND

Various factors threaten the health and recovery of hospitalized elderly, including stressors in medical service centers. Therefore, the aim of the present study was to develop and preliminary validate a measurement tool to assess hospitalization-related stressors (HRS) among the elderly.

MATERIALS AND METHODS

This methodological research was conducted in 2015. The study was performed in two main phases. In the first phase, which was to develop the questionnaire, the data were collected through literature review, interview with few elderly patients, and calculating content validity index with the participation of 16 experts. The second phase included preliminary validation of the questionnaire in which a convenient sample of 200 hospitalized elderly patients recruited from 4 educational medical centers of the Isfahan University of Medical Sciences were studied. Principal component analysis method was used to identify the factorial structure of the questionnaire. In order to evaluate validity, Cronbach's alpha coefficient was calculated.

RESULTS

After evaluating the results and relocating and merging some of the items, a version of 26 items in 7 categories was prepared with acceptable internal consistency (Cronbach's alpha coefficient from 0.67 to 0.78 for the components and 0.83 for the tool).

CONCLUSIONS

In this study, we were able to identify a set of important components and indicators of HRS in elderly; so it can be used as a useful instrument. Future studies are recommended in order to develop and validate this tool in other communities.

Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists

Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1) and 868 patients (part 2) were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%). In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524) and approved by the ethical committee.

Stressors in intensive care units in Syria: patients' perceptions

The purpose of this cross-sectional study was to identify the stressors and the level of stress as perceived by hospitalised Syrian patients of intensive care units (ICUs). A convenience sample of 150 Syrians who were hospitalised in ICUs located in the Syrian capital, Damascus, were chosen as study participants and were interviewed using a structured interview guide of the Intensive Care Units Environmental Stressors Scale (ICUESS). The findings revealed that physical stressors were perceived as the most stressful ones, whereas psychological stressors were the least stressful. These findings are congruent with the majority of similarly available regional and international literature. It was also statistically noticed that participants with a higher level of education and income were more sensitive in perceiving the stressors than those who had a lower level of education and income. The findings suggested that nurses must utilise effective measures in ICUs to relieve patients' pain and provide a humane ICU environment and atmosphere in which rest is enabled. In conclusion, decreasing the stress level has a positive impact on patients' health outcomes, where adequate attention to patients' physical and psychological domains should equally be considered.

Physiological responses to passive exercise in adults receiving mechanical ventilation

BACKGROUND

Critical illness may weaken muscles, with long-term consequences.

OBJECTIVE

To assess physiological responses to an early standardized passive exercise protocol to prevent muscle weakness in adults receiving mechanical ventilation.

METHODS

A quasi-experimental within-subjects repeated-measures design was used. Within 72 hours of intubation, 30 patients had 20 minutes of bilateral passive leg movement delivered by continuous-passive-motion machines at a standardized rate and flexion-extension. Heart rate, mean blood pressure, oxygen saturation, and cytokine levels were measured before, during, and after the intervention. The Behavioral Pain Scale was used to measure patients' comfort. Repeated-measures analysis of variance was used to analyze the effect of the exercise on independent variables.

RESULTS

Patients were mostly white men with a mean age of 56.5 years (SD, 16.9) with moderate mortality risk and illness severity. Heart rate, mean blood pressure, and oxygen saturation did not differ from baseline at any time measured. Pain scores were significantly reduced (F(2.43,70.42) = 4.08; P = .02) 5 and 10 minutes after exercise started and remained reduced at the end of exercise and 1 hour later. Interleukin 6 levels were significantly reduced (F(1.60,43.1) = 4.35; P = .03) at the end of exercise but not after the final rest period. Interleukin 10 levels did not differ significantly. Ratios of interleukin 6 to interleukin 10 decreased significantly (F(1.61,43.38) = 3.42; P = .05) at the end of exercise and again after 60 minutes' rest.

CONCLUSION

The exercise was well tolerated, and comfort improved during and after the intervention. Cytokine levels provided physiological rationale for benefits of early exercise.

The effect of a family support intervention on physician, nurse, and family perceptions of care in the surgical, neurological, and medical intensive care units

Many patients in the intensive care unit (ICU) have predictable medical and discharge outcomes, but some trajectories are marked with medical uncertainty. Stressed family-surrogates receive multiple medical updates from a variety of personnel. These circumstances can lead to confusion, which may result in conflicts and dissatisfaction with care. This study examined the effects of adding a family support coordinator to the surgical, neurological, and medical ICUs on family, physician, and nurse satisfaction with communication and care. A quasi-experimental design was conducted in 2 sequential phases (baseline and intervention). The data sources were 2 surveys: (1) Family Satisfaction Survey and (2) Nurse and Physician Perception and Satisfaction Survey. Family Satisfaction Survey data, a combined data set, were collected in the 3 ICUs. Nurse and Physician Perception and Satisfaction Survey data were collected from the attending physicians and critical care nurses in the medical and neurological ICUs. Results show that family ratings of satisfaction with ICU team communication and care generally increased as a result of the intervention. Overall, physician and nurse perceptions of communication and care did not change as a result of the intervention.

Tend and befriend in the intensive care unit

Stress is a common phenomenon in the intensive care unit for both patients and nurses. Critical care nurses may experience many forms of stress, including physical, psychological, and moral stress or distress. The physiological stress response traditionally associated with the hypothalamic-pituitary-adrenal axis has been expanded to include a new model, called tend and befriend, that has been linked to females of different species, including humans. Studies have shown that stress also affects immune function. Although commonly associated with adverse outcomes, stress can lead to personal growth. The tend and befriend strategy is an intervention that was developed to help nurses increase their ability to grow from stressful situations, especially those related to moral distress.

Patient and nurse perceptions of stressors in the intensive care unit

The objective of the study was to determine the perceptions of a group of patients on intensive care units' (ICUs) stressors and the perceptions of nurses on ICU patients' stressors in Turkey, and compare the differences in patients' and nurses' perception of the stressors in ICUs. In this descriptive study, 155 patients who were admitted to medical or surgical ICUs and 152 nurses who are employed in the same units of two training and research hospitals in Turkey were enrolled in this study. The ICU Environmental Stressor Scale (ICUESS) was used to determine intensive care stressors. According to total ICUESS mean scores, patients (91.41 ± 34.91) perceived significantly less stress than the ICU nurses (133.23 ± 32.20) perceived them to have. Both patients and nurses ranked 'fear of death' as the greatest stressor. Physiological stressors were identified as the most important stressors by both patients and nurses. Patients and nurses in medical ICUs were more affected by stressors than their counterparts in surgical ICUs. Patients with unplanned or emergency admissions perceived higher stress than that of patients with planned admissions. Several factors could help reduce these stressors, such as having familiar arrangements, humane ICU environment, individual patient assessments and appropriate nursing interventions.

Health-related quality of life and its main related factors among nurses in China

The present study is to evaluate the health-related quality of life (HRQOL) and analyze the effect of occupational stress, job burnout and coping resource on the HRQOL among nurses in China. A total of 1,012 nurses were recruited from eight hospitals of two provinces in 2008. The Chinese version of Short Form-36 Health Survey and Maslach Burnout Inventory-General Survey were used to measure the HRQOL and burnout respectively, the Occupation Stress Inventory-Revised Edition was used to evaluate occupational stressor, personal strain and coping resources. Other potential influencing factors for HRQOL were collected using a structured questionnaire. HRQOL in the nurses was lower than that in the general population. Occupational stressor, personal strain and job burnout correlated negatively with the HRQOL (p<0.05) while coping resources was positively related to the HRQOL (p<0.05). Among the predictive factors for HRQOL, occupational stressor (indicated by role insufficiency and physical environment), personal strain (indicated by physical strain and psychological strain), job burnout (indicated by emotional exhaustion and professional efficacy), length of work hours (≥10 h per day), diet irregularity and age were the main risk factors for HRQOL, while recreation and self-care were the main protective factors for HRQOL. The findings suggest occupational stress, job burnout and coping resources play important roles in HRQOL in the Chinese nurses.