The relationship between stressors and intensive care unit experiences

Longitudinal trajectories of health-related quality of life among critical care survivors: A latent class growth approach

OBJECTIVES

This study explored the trajectories of health-related quality of life (HRQOL) and the factors influencing these trajectories.

RESEARCH METHODOLOGY/DESIGN

Prospective observational cohort study.

SETTING

19 intensive care units (ICUs) in South Korea.

MAIN OUTCOME MEASURES

We used the Medical Outcomes Study Short Form version 2 (SF-36v2) to assess HRQOL at 3, 6, 12, and 24 months post-discharge. Additionally, we evaluated intensive care experience, post-intensive care syndrome, and demographic and clinical characteristics to identify factors. HRQOL trajectory groups were identified via latent class growth modeling, with determining factors analyzed using multinomial logistic regression.

RESULTS

The analysis identified three distinct groups for the physical component summary (PCS) and mental component summary (MCS) of the SF-36v2. For the PCS, the groups were labeled "Resilient Stable," "Moderate Recovered," and "Slow Recovering." For the MCS, the classifications were "Resilient Stable," "Low Recovered," and "Persistent Low." The determinants of the PCS Moderate Recovered and Slow Recovering Groups included older age, female gender, less educated, increased comorbidities, discharge to extended care facilities, and post-intensive care syndrome. Conversely, the MCS Low Recovered and Persistent Low Groups were determined by the intensive care experience and post-intensive care syndrome.

CONCLUSION

Our study identified specific vulnerable groups for PCS and MCS and their determinants in terms of HRQOL recovery among ICU survivors.

IMPLICATIONS FOR CLINICAL PRACTICE

There is a need for a preemptive approach for survivors with determinants that place them in vulnerable groups for poorer HRQOL as well as systematic monitoring of post-intensive care syndrome in various healthcare settings.

Music-based interventions and theoretical mechanisms in post-ICU survivors: A critical narrative synthesis

BACKGROUND

Hospitalization in the ICU can have long-term physiological and psychological impacts, affecting functional recovery and quality of life of post-ICU patients. Despite systematic reviews showing the impact of music interventions on physiological and psychological outcomes in ICU patients, their applicability and effectiveness in the post-ICU context remain unclear.

AIM

This review aimed to summarize: a) the types and characteristics of music/sound of interventions used in the rehabilitation of ICU patients, b) evidence on the feasibility, safety and acceptability of sound and music interventions for post ICU survivors, c) the types of post-ICU outcomes explored and the effects of sound and music interventions on any type of outcome in post-ICU survivors, and d) potential mechanisms or theoretical frameworks underlying the effects of sound and music interventions.

METHOD

We combined current systematic review search methods with a critical narrative approach to synthesize a diverse body of evidence.

RESULTS

Results showed that music interventions positively affect the psychological well-being and health outcomes of post-ICU patients. Outcomes included improvements in stress, anxiety, mood, movement, sleep, and pain, despite differences in patient populations and intervention design. No safety concerns were reported. The identified theoretical frameworks described physiological, neurobiological and/or psycho-social pathways as key mediators, however, these mechanisms are not completely understood.

CONCLUSION

Research evidence supports the positive effects of music interventions in post-ICU patients. Further experimental studies are required, especially in adult post-ICU populations to elucidate the characteristics, components, feasibility, and long-term effects of sound/music interventions.

IMPLICATION TO PRACTICE

1. Music interventions help in post-ICU patients' recovery benefitting stress, anxiety, PTSD, mood, movement, sleep, and pain. 2. Integrating theoretical frameworks into music interventions can expand outcome measures to include physiological markers alongside psychological ones, improving quality of life. 3. Further rigorous interventional studies are required to identify the effectiveness of sound and music interventions in post-ICU patients.

Screening pediatric patients to determine need for child life services using the pediatric emotional safety screener

There can be adverse psychosocial outcomes for children who have negative healthcare experiences. Identifying children's risk for experiencing elevated distress early on when entering the healthcare setting would allow targeted, proactive support to help mitigate negative psychological sequelae. The aim of this retrospective study was to evaluate the psychometric properties of the Pediatric Emotional Safety Screener (PESS), designed to screen for psychosocial distress for pediatric patients. A Child Life Department conducted a program evaluation, screening 1643 patients using the PESS in six different service areas including acute inpatient, critical care, emergency department, radiology, surgery, and ambulatory clinics. Certified child life specialists (CCLS) completed a Psychosocial Risk Assessment in Pediatrics (PRAP) and provided their assessment of priority level for child life support for each patient screened. Secondary analysis of the data evaluated the psychometric properties of the PESS. Findings indicated good internal consistency for the PESS. PESS scores significantly correlated with both PRAP scores and CCLS priority level. The PESS is a promising standardized method for health-care providers to screen pediatric patients' risk for experiencing significant distress during their healthcare visit to determine the need for support from a CCLS.

Reimagine the ICU: Healthcare Professionals' Perspectives on How Environments (Can) Promote Patient Well-Being

OBJECTIVE

This study aims (1) to understand the needs and challenges of the current intensive care unit (ICU) environments in supporting patient well-being from the perspective of healthcare professionals (HCPs) and (2) to explore the new potential of ICU environments enabled by technology.

BACKGROUND

Evidence-based design has yielded how the design of environments can advocate for patient well-being, and digital technology offers new possibilities for indoor environments. However, the role of technology in facilitating ICU patient well-being has been unexplored.

METHOD

This study was conducted in two phases. First, a mixed-method study was conducted with ICU HCPs from four Dutch hospitals. The study investigated the current environmental support for care activities, as well as the factors that positively and negatively contribute to patient experience. Next, a co-creation session was held involving HCPs and health technology experts to explore opportunities for technology to support ICU patient well-being.

RESULTS

The mixed-method study revealed nine negative and eight positive patient experience factors. HCPs perceived patient emotional care as most challenging due to the ICU workload and a lack of environmental support in fulfilling patient emotional needs. The co-creation session yielded nine technology-enabled solutions to address identified challenges. Finally, drawing from insights from both studies, four strategies were introduced that guide toward creating technology to provide holistic and personalized care for patients.

CONCLUSION

Patient experience factors are intertwined, necessitating a multifactorial approach to support patient well-being. Viewing the ICU environment as a holistic unit, our findings provide guidance on creating healing environments using technology.

Measuring the intensive care experience of intensive care unit patients: A cross-sectional study in western China

BACKGROUND

The negative experiences of intensive care unit (ICU) patients seriously affect their quality of life and survival outcomes. Thus, it is of great significance to evaluate the monitoring experience of ICU patients for the clinical improvement of their experiences and promote interventions.

OBJECTIVES

The objective of this study was to investigate patients' experiences of ICU and to understand the sources of patient experience and influencing factors.

METHODS

From November 2021 to September 2022, a cross-sectional survey was conducted with 600 inpatients from four grade A-III hospitals in western China. Data were collected using the Chinese version of the Intensive Care Experience Questionnaire.

RESULTS

585 valid questionnaires were collected, the response rate was 97.5%. ICU patients in western China scored below-the-average for their intensive care experience. Family monthly income, occupation types, medical payment method, type of ICU, ICU admission plan, ICU admission times, mechanical ventilation use, fertility status, analgesia, sedation, and Acute Physiology and Chronic Health Evaluation II scores are important factors influencing ICU patients' intensive care experience.

CONCLUSIONS

Medical staff need to pay attention to patient experience, improve the awareness of patient stressors and influencing factors, design nursing programs conducive to patient-positive experience, and promote interventions to further improve the long-term prognosis of patients. The results of this study can also be used as a set of nursing-sensitive indicators for evaluating nursing structure, process, and outcomes.

Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study

OBJECTIVE

to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not.

METHOD

a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not.

RESULTS

67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures.

CONCLUSION

the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study

OBJECTIVE

to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not.

METHOD

a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not.

RESULTS

67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures.

CONCLUSION

the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Self-reported symptoms experienced by intensive care unit patients: a prospective observational multicenter study

PURPOSE

The purpose of this study is to describe the prevalence, intensity and distress of five symptoms in intensive care unit (ICU) patients and to investigate possible predictive factors associated with symptom intensity.

METHODS

This is a prospective cohort study of ICU patients. A symptom questionnaire (i.e., Patient Symptom Survey) was used to describe the prevalence, intensity and distress of pain, thirst, anxiousness, tiredness, and shortness of breath over seven ICU days. Associations between symptom intensity and possible predictive factors were assessed using the general estimating equation (GEE) model.

RESULTS

Out of 603 eligible patients, 353 (Sample 2) were included in the present study. On the first ICU day, 195 patients (Sample 1) reported thirst as the most prevalent symptom (66%), with the highest mean intensity score (6.13, 95% confidence interval (CI) [5.7-6.56]). Thirst was the most prevalent (64%) and most intense (mean score 6.05, 95%CI [5.81-6.3]) symptom during seven days in the ICU. Anxiousness was the most distressful (mean score 5.24, 95%CI [4.32-6.15]) symptom on the first day and during seven days (mean score 5.46, 95%CI [4.95-5.98]). During seven days, analgesic administration and sepsis diagnosis were associated with increased thirst intensity. Older age and being mechanically ventilated were associated with decreased pain intensity, and analgesic administration was associated with increased pain intensity. Family visits and female gender were associated with increased intensity of anxiousness and shortness of breath, respectively.

CONCLUSIONS

Self-reporting ICU patients experienced a high and consistent symptom burden across seven days. Certain variables were associated with the degree of symptom intensity, but further research is required to better understand these associations.

The impact of family care visitation programme on patients and caregivers in the intensive care unit: A mixed methods study

AIMS

To track changes in the haemodynamic and respiratory indicators of patients and evaluate families' caring experiences via the visitation programme in the intensive care unit (ICU).

BACKGROUND

Although most people recognise the importance of family care visitation programme in the ICU, objective research results on the effect on patients and caregivers are still insufficient.

DESIGN

Mixed methods.

METHODS

In this a quasi-experimental investigation and qualitative study, after executing the programme with families of ICU patients in a general hospital in South Korea from June to July 2019, changes in haemodynamic and respiratory indicators for control (n = 28) and experimental groups (n = 28) were analysed; the experimental group families' experiences were analysed through in-depth interviews; the qualitative study's reporting rigour was checked against the COREQ guidelines and TREND checklist for a quasi-experimental study. Qualitative and quantitative data were examined using content analysis and repeated-measures analysis of variance, respectively.

RESULTS

There was a significant change in systolic and diastolic blood pressure in the haemodynamic indicator, and the respiratory indicator in both groups increased slightly over time and then gradually stabilised; there were no significant differences or interactions between groups regarding time of systolic blood pressure. The respiratory rate significantly decreased only in the experimental group. There was a significant increase in oxygen saturation over time, as well as interactions between time and group and between groups. Four themes were extracted from families' experiences.

CONCLUSION

The haemodynamic and respiratory indicators of the group using patient- and family-centred care (PFCC) showed a stable effect on critically ill patients, which increased families' satisfaction. In future, interventions should encourage family participation in the ICU for successful PFCC.

RELEVANCE TO CLINICAL PRACTICE

The findings provided evidence for the importance of PFCC through changes in objective haemodynamic and respiratory indicators.

The effectiveness of music interventions on stress response in intensive care patients: A systematic review and meta-analysis

AIM AND OBJECTIVE

To investigate the effectiveness of music interventions on physiological and psychological stress response in intensive care unit (ICU) patients.

BACKGROUND

ICU patients are exposed to several physiological and psychological stressors during their treatments. Music interventions can be implemented to control these negative effects.

DESIGN

Systematic review and meta-analysis conducted according to PRISMA Guidelines.

METHOD

This meta-analysis was conducted per PRISMA guidelines. Seven electronic literature databases, reference lists of similar reviews, grey literature and the Clinical Trials Registry were searched for potential studies up to 30 September 2021. Studies were expected to meet PICOS inclusion criteria. Two reviewers independently assessed the risk of bias of the included studies by using the Cochrane Collaboration tool. Overall, meta-analysis and subgroup analyses (comparator group and music session frequency) were performed using RevMan 5.4. Meta-analysis was conducted when data were available; otherwise, a narrative description was provided.

RESULTS

Twenty-five articles were included in this review. Music intervention was found to provide reductions in anxiety levels concerning psychological stress. However, it was found that music had an effect only on the systolic blood pressure level concerning the physiological stress and had no effect on the diastolic blood pressure, respiration rate or heart rate. In the subgroup analysis performed against the comparator groups, it was found that music decreased the anxiety level compared to the standard care group but was not effective compared to the noise reduction group. It was found that multiple music sessions reduced the anxiety level better than a single music session.

CONCLUSIONS

Music interventions involving multiple sessions can be used as a nursing intervention to control the anxiety levels of ICU patients.

RELEVANCE TO THE CLINICAL PRACTICE

Using music to reduce anxiety and stress levels may reduce the pharmacological need (for sedative or antipsychotic medications) and the risk of associated side effects in ICU patients.

The Effect of Environmental Stressors on Patient Experience in Medical, Surgical, and COVID-19 Intensive Care Unit

This study was conducted to evaluate the effects of environmental stressors on patients’ intensive care experiences in medical, surgical, and COVID-19 intensive care units (ICUs). The sample group consisted of 231 patients hospitalized in medical and surgical ICUs and agreed to participate in the study. The data analysis was performed with IBM SPSS Statistics 25. The average age of the patients was 53.67 ± 13.3, 55.4% were male, 47.6% were high school graduates, and 45.5% were followed up in the COVID-19 ICU. It was also found that there was a negative and moderate degree of correlation between the Intensive Care Experience Scale (ICES) and the Intensive Care Unit Environmental Stressors Scale (ICUESS). Environmental stressors in ICUs are associated with patient experiences. It is clear that ICU stressors create a negative perception in the patient and this situation is emotionally exhausting.

A Neurobiological Framework for the Therapeutic Potential of Music and Sound Interventions for Post-Traumatic Stress Symptoms in Critical Illness Survivors

Overview: Post traumatic stress disorder (PTSD) has emerged as a severely debilitating psychiatric disorder associated with critical illness. Little progress has been made in the treatment of post-intensive care unit (ICU) PTSD. Aim: To synthesize neurobiological evidence on the pathophysiology of PTSD and the brain areas involved, and to highlight the potential of music to treat post-ICU PTSD. Methods: Critical narrative review to elucidate an evidence-based neurobiological framework to inform the study of music interventions for PTSD post-ICU. Literature searches were performed in PubMed and CINAHL. The Scale for the Assessment of Narrative Review Articles (SANRA) guided reporting. Results: A dysfunctional HPA axis feedback loop, an increased amygdalic response, hippocampal atrophy, and a hypoactive prefrontal cortex contribute to PTSD symptoms. Playing or listening to music can stimulate neurogenesis and neuroplasticity, enhance brain recovery, and normalize stress response. Additionally, evidence supports effectiveness of music to improve coping and emotional regulation, decrease dissociation symptoms, reduce depression and anxiety levels, and overall reduce severity of PTSD symptoms. Conclusions: Despite the lack of music interventions for ICU survivors, music has the potential to help people suffering from PTSD by decreasing amygdala activity, improving hippocampal and prefrontal brain function, and balancing the HPA-axis.

Noise reduction in the ICU: a best practice implementation project

INTRODUCTION

Sleep deprivation is a relevant problem among patients hospitalized in ICUs. Further, noise is the most critical disruptive factor according to patients.

OBJECTIVE

To implement scientific evidence-based best practices for noise control in an adult ICU.

METHODS

This was an evidence-based implementation project of best practices in noise control, conducted in a high-complexity hospital's adult ICU. The intervention consisted of three steps: baseline audit and identification of barriers, implementation of best practices, and a follow-up audit.

RESULTS

No compliance with best practices was detected in the baseline audit. After the implementation phase, the unit reached compliance levels of 78-88% for most of these criteria only one criterion related to noise level did not match the expected compliance.

CONCLUSION

Adherence to best practices regarding noise control was satisfactory, achieving more than 70% compliance in the six audit criteria. Only the noise level did not reach the threshold recommended by the WHO - a difficulty reported in other studies.

RELEVANCE TO CLINICAL PRACTICE

Best practices related to noise control are essential for managing sleep deprivation in ICUs and include changes in the behaviour of involved professionals.

Pupil Light Reflex for the Assessment of Analgesia in Critically Ill Sedated Patients With Traumatic Brain Injury: A Preliminary Study

ABSTRACT

BACKGROUND: Analgesia monitoring is essential to preserve comfort in critically ill sedated patients with traumatic brain injury (TBI). Although pupil dilation (PD) and pain behaviors can be used to assess analgesia, these indicators require application of noxious stimulations for elicitation. Recently, the pupillary light reflex (PLR) has emerged as a nonnoxious parameter that may be used to predict analgesia requirements in non-brain-injured patients. Here, we explored whether PLR can be used for the purpose of analgesia monitoring in critically ill sedated TBI patients. METHODS: Fifteen mechanically ventilated TBI patients (11 men; 54 ± 20 years) under continuous analgesia and sedation infusions were assessed at predefined time within 72 hours of intensive care unit admission. Data collection was performed using video-pupillometry and the Behavioral Pain Scale. At each assessment, pupil size and PLR at rest were recorded followed immediately by the documentation of PD and pain behaviors elicited by a calibrated noxious stimulus. Blood concentrations of analgesics/sedatives were monitored. RESULTS: One hundred three assessments were completed. PLR resulted in an average decrease of 19% in pupil diameter, and PD resulted in an average increase of 10% in pupil diameter. Variations in PLR and PD were more pronounced in subjects who showed a Behavioral Pain Scale score greater than 3 (a recognized sign of subanalgesia) compared with those with no behavioral reaction. Multiple regression analyses suggest a significant overlap between fluctuations in pupillary reflexes and blood levels of fentanyl, not propofol. CONCLUSION: In our sample, percentages of variation in PLR and PD were found to be directly representative of TBI patients' fentanyl blood concentration. Considering information about blood drug concentration is generally not available at bedside, PLR could be used as a proxy to assess analgesia requirements before a nociceptive procedure in critically ill sedated TBI patients who are vulnerable to stress.

Patients' experiences in the intensive care unit in Jordan: A cross-sectional study

AIMS

The purpose of this study was to describe the experiences of Jordanian patients during their stay in intensive care unit (ICU) and to explore associated factors.

BACKGROUND

Various factors can negatively affect patients' experiences and lead to negative consequences that can affect their outcomes.

MATERIALS & METHODS

A descriptive, correlational design was used to collect data from 150 patients using the Intensive Care Experience Questionnaire through structured interviews after being transferred from medical and surgical ICUs to general wards.

RESULTS

The results showed that the longer the length of ICU stay (LOS) (>7 days) the higher frightening experience (r = 0.2, p < 0.05), the lower awareness of surrounding (r = -0.28, p < 0.01), and the lower satisfaction with care (r = -0.22, p < 0.01). The results showed a negative correlation between receiving sedation and awareness of surroundings (r = -0.33, p < 0.01), and recall of ICU experiences (r = -0.23, p < 0.01), and a positive correlation with frightening experiences (r = 0.2, p < 0.05).

CONCLUSION

Health care activities, clinical and socio-demographic factors can affect the psychological experiences of patients in the ICU. Longer ICU stay is associated with more negative experiences.

A qualitative study of nurses' perception on patients' thirst in intensive care units

BACKGROUND

Thirst is a prevalent and intense symptom among patients in intensive care units. Occurrence of thirst in the intensive care unit cannot be avoided because of the nature of critical illnesses and their treatments like the side effects of administered medication or dehydration. In the intensive care unit, nurses have the opportunity and responsibility to prevent and reduce thirst by recognizing the different types of thirst. Thus, knowing nurses' perception on patients' thirst is crucial.

OBJECTIVES

Exploration of intensive care nurses' perception on patients' thirst.

RESEARCH DESIGN

A qualitative descriptive study.

METHODS

Data were collected from December 2020 to January 2021 and analyzed by using a phenomenographic methodology. Data were transcribed verbatim and thematic analysis was performed.

RESULTS

Sixteen nurses, in Chongqing, China, aged 25-48 years, were interviewed. Four themes emerged: (1) perceived barriers for thirst; (2) perceived signs of thirst; (3) perceived reasons of thirst; (4) perceived consequences for thirst. Overall nurses' perception of patients' thirst is poor. Nurses give a low priority and insufficient attention to the issue of thirst in intensive care patients.

CONCLUSION

Intensive care nurses' perception on thirst in patients should be evaluated and, if necessary, this issue should be given more attention in training in order to create sufficient awareness about the topic.

Thirst in patients admitted to intensive care units: an observational study

Background

Despite various studies reporting a high prevalence, reaching 71%, the sensation of thirst in intensive care unit (ICU) patients, its prevention, detection, and management, is not well known nor considered. Limited research has examined the causes of thirst in ICU patients, while it has been examined in other patient populations.

Aim

To determine the incidence and intensity of thirst in patients admitted to ICU and its association with airway devices (endotracheal tube, tracheostomy, oxygen mask), airway humidification, patients’ characteristics, and therapy (serum sodium concentration, hematocrit, fluid balance, possibility of oral hydration, and dosage of diuretics).

Methods

Patients were interviewed daily to report the presence of thirst and rate its intensity on a Numeric Rating Scale (NRS) from 0 (no thirst) –10 (intolerable thirst). Other data were obtained through direct evaluation or by consulting medical records. Patients admitted to three ICUs from May to August 2014 in a university hospital in Italy were included.

Results

A total of 220 Patients were enrolled. Thirst was found in 76.1% of patients’ observations, with a mean thirst score of 5.37. Thirst intensity was predicted by high doses of diuretics (> 100 mg/die), increasing serum sodium concentration, absence of oral hydration and the presence of xerostomia. Thirst was associated with the use of humidified Venturi mask.

Conclusions

Thirst is highly prevalent among patients in this population of intensive care patients. It would be desirable to evaluate this stressor at least daily, to eliminate or relieve this sensation.

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.

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.