Care training and family caregiver anxiety: prospective cohort study

OBJECTIVES

The study aimed to improve family caregivers' skills and evaluate the effect on their anxiety levels.

METHOD

In our study, family caregivers of patients unable to perform daily activities were provided with care training. Their anxiety levels were examined before and after the training.

RESULTS

Care training increased the family caregivers' sense of self-efficacy but caused no significant difference in their anxiety levels. Factors such as gender, education level and employment status influenced anxiety levels. Higher education and income were associated with lower trait anxiety while employment status was linked to higher anxiety levels.

CONCLUSION

Care training increased the family caregivers' sense of self-efficacy while causing no difference in their anxiety levels. In order to reduce anxiety, other negative factors affecting the caregiver should be discovered and corrected.

Postintensive care syndrome family: A comprehensive review

Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20-40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F.

Effects of an online information tool on post-traumatic stress disorder in relatives of intensive care unit patients: a multicenter double-blind, randomized, placebo-controlled trial (ICU-Families-Study)

PURPOSE

Intensive care unit (ICU) hospitalization is challenging for the family members of the patients. Most family members report some level of anxiety and depression, sometimes even resulting in post-traumatic stress disorder (PTSD). An association has been reported between lack of information and PTSD. This study had three aims: to quantify the psychological burden of family members of critically ill patients, to explore whether a website with specific information could reduce PTSD symptoms, and to ascertain whether a website with information about intensive care would be used.

METHOD

A multicenter double-blind, randomized, placebo-controlled trial was carried out in Austria and Switzerland.

RESULTS

In total, 89 members of families of critically ill patients (mean age 47.3 ± 12.9 years, female n = 59, 66.3%) were included in the study. 46 relatives were allocated to the intervention website and 43 to the control website. Baseline Impact of Event Scale (IES) score was 27.5 ± 12.7. Overall, 50% showed clinically relevant PTSD symptoms at baseline. Mean IES score for the primary endpoint (~ 30 days after inclusion, T1) was 24 ± 15.8 (intervention 23.9 ± 17.9 vs. control 24.1 ± 13.5, p = 0.892). Hospital Anxiety and Depression Scale (HADS - Deutsch (D)) score at T1 was 12.2 ± 6.1 (min. 3, max. 31) and did not differ between groups. Use of the website differed between the groups (intervention min. 1, max. 14 vs. min. 1, max. 3; total 1386 "clicks" on the website, intervention 1021 vs. control 365). Recruitment was prematurely stopped in February 2020 due to coronavirus disease 2019 (COVID-19).

CONCLUSION

Family members of critically ill patients often have significant PTSD symptoms and online information on critical illness did not result in reduced PTSD symptoms.

Risk factors associated with post-intensive care syndrome in family members (PICS-F): A prospective observational study

Background

The family members of intensive care unit (ICU) patients play a crucial role in modern ICUs. These individuals are predisposed to the development of post-intensive care syndrome in family members (PICS-F), a syndrome experienced by family members of ICU patients in response to critical illness and characterised by new or worsening psychological symptoms. This study sought to evaluate the levels of anxiety and depression exhibited by the family members of patients hospitalised in the ICU. It also aimed to identify the risk factors associated with the experience of PICS-F, which should assist with its prevention in the future.

Methods

The study sample comprised 164 ICU patients and their family members. Sociodemographic data were gathered at the time of ICU admission and 3 months after discharge, and the family members were screened for emotional distress using the Hospital Anxiety and Depression Scale (HADS). Comparison tests were used to test for an association between family/patient characteristics and a positive HADS score. In addition, a multivariable logistic regression model was constructed to identify the independent factors associated with a positive HADS score.

Results

Emotional distress was identified in 24% of the family members 3 months after their relatives had been discharged from the ICU. A number of personal traits were found to be associated with emotional distress in the family members, namely unemployment (p = .008), smoking/drinking habits (p = .036) and personal history of psychopathology (p = .045). In the multiple logistic regression analyses, only unemployment was found to be an independent factor associated with both anxiety and depression in the family members (OR = 2.74, CI 95%: 1.09-6.93). No association was found between the patients' characteristics and emotional distress in the family members.

Conclusions

The findings of this study indicate an association between emotional distress in the family members of ICU patients and their personal traits, thereby building on the prior literature by suggesting that patient characteristics are less pertinent to the experience of PICS-F. Unemployment may represent a meaningful risk factor for emotional distress in family members (a potential marker of PICS-F), given its relationship with family members' positive HADS scores post-ICU discharge. These findings should influence preventative strategies concerning PICS-F by illustrating the need to assess family characteristics and demographics early in a patient's ICU stay and, consequently, allowing for the early identification of at-risk individuals and the prompt implementation of adequate support services.

Anxiety and Depression Symptoms of Family Members of Intensive Care Unit Patients: A Prospective Observational Study and the Lived Experiences of the Family Members

Background  The aim of this study is to investigate the factors affecting symptoms of anxiety and depression in the family members of critically ill patients. Methods  This prospective cohort study was conducted in an adult tertiary care mixed medical-surgical intensive care unit (ICU) at a tertiary-level teaching hospital. The symptoms of anxiety and depression of first-degree adult relatives were evaluated with the Hospital Anxiety and Depression Scale. Four family members were interviewed and asked about their experiences during the ICU process. Results  A total of 84 patients and their family members were included in the study. The symptoms of anxiety were present in 44/84 (52.4%), and depression was present in 57/84 (67.9%) family members. A nasogastric tube was found to be related to anxiety ( p  = 0.005) and depressive symptoms ( p  = 0.002). The family members of the patients with an acute developed illness had 3.9 (95% confidence interval [CI]: 1.4-10.9) times the odds of having the symptoms of anxiety and 6.2 (95% CI: 1.7-21.7) times the odds of having the symptoms of depression than the family members of the patients with an illness developed on a chronic basis. The family members of the patients who died in the ICU had 5.0 (95% CI: 1.0-24.5) times the odds of being depressed than the patients discharged from the ICU. All interviewees stated having difficulty understanding and remembering what was told. The common feelings of all the interviewees were desperation and fear. Conclusions  Awareness of the emotional stress of family members can help develop interventions and attitudes to alleviate symptom burden.

Nurse information in Spanish intensive care units: Formal or informal role? Multicentre study

OBJECTIVES

To evaluate the brochure provided to relatives on admission to Spanish Intensive Care Units (ICU) regarding nursing information.

METHODOLOGY

Descriptive, cross-sectional, multicentre study from September-December 2019. A total of 280 adult ICUs were included, according to the list of the Spanish Society of Intensive Care. The brochure was requested through personal contact, phone call, twitter, or hospital website.

ANALYSED VARIABLES

Hospital (public/private), university (yes/no), visiting (open/closed), medical and nurse information. Descriptive statistics and X² test (relations nurse information and other variables).

RESULTS

Data were collected from 228 ICU (81.4%), of which 25 (11%) did not have a brochure. A total of 77.8% were public and 49.8% university hospitals. Of the hospitals, 94.1% had closed visiting hours, although 42.4% supplemented it with flexible. All the hospitals included daily medical information with an established timetable, 21.7% (n = 44) contained nurse information, 27.3% with established hours and 38.6% during visits. Of the nursing information, 79.5% referred to care, 29.5% to needs, 13.6% to well-being, 15.9% to the patient's condition, 11.4% to the environment, 9.1% to observations, and 29.5% to clarifications. A total of 17.2% of all ICU offered to collaborate in care. Of the brochures with nurse information, 90.9% were public hospitals and 9.1% were private (p = .02). Of the hospitals, 65.9% were university compared to 34.1% who were not (p = .02).

CONCLUSIONS

While medical information is consistently reflected in all brochures, only a few contain nursing information with generic and non-homogeneous and specific content. These results contrast with the reality of the ICU, where the nurse is the professional with the greatest contact with the family. The official provision of nursing information occurs more frequently in public and university hospitals. It is necessary to standardise this information, since as a responsible part of the care process, nurses must communicate their care in a formal manner, and thus help make their work visible.

Individual factors in dignified care: a cross-sectional study of critical care nurses

AIM

To determine the level of dignified care provided by critical care nurses and to explore the associated individual factors.

BACKGROUND

Dignity is a fundamental right of human beings. Critically ill patients are dependent on nurses. Their need for respect and dignity is liable to be neglected in intensive care unit settings. Both critically ill survivors and dying patients suffer mental anguish due to loss of dignity.

METHOD

This was a cross-sectional study of 526 critical care nurses working at intensive care units for adults in Zhejiang Province, China. Data were collected from February 2021 to May 2021 using the Intensive Care Unit Dignified Care Questionnaire, Wong and Law Emotional Intelligence Scale, Jefferson Scale of Empathy-Health Professional, Nurses Professional Values Scale-Revised.

RESULTS

The total score of dignified care was 67.37 (8.83), with the standard score as 74.07 (12.99). Participants who performed poorly in absolute and relative dignity accounted for 8.4% and 31.2% of the total sample, respectively. Emotional intelligence (β = 0.379, p < .001), empathy (β = 0.319, p < .001), professional values (β = 0.147, p < .001), age (β = 0.075, p = .003), and training in dignified care (β = 0.074, p = .010) were associated with dignified care, explaining 67.6% of the variance.

CONCLUSION

The average level of participants' behaviors of maintaining patient dignity was medium. Critical care nurses need to improve their ability to maintain relative dignity of patients. Emotional intelligence, empathy, professional values, age level, and training in dignified care were predictors of dignified care.

IMPLICATIONS FOR NURSING MANAGEMENT

Improving emotional intelligence, empathy, and professional values of critical care nurses and training them (especially less experienced nurses) will enhance their ability in dignified care. This study provides a novel perspective to help nursing managers develop interventions to promote humanized care in the intensive care unit.

[Ways of supporting relatives in intensive care units : Overview and update]

Hintergrund

Angehörige von kritisch Kranken auf der Intensivstation („intensive care unit“, ICU) sind in einer herausfordernden Situation: Sie befinden sich häufig in einer existenziellen Krise mit einer großen emotionalen Belastung, gleichzeitig sind sie oftmals aktiv in therapeutische Entscheidungen mit eingebunden. Die Besuchsrestriktionen während der Pandemie aufgrund der Coronaviruserkrankung 2019 (COVID-19) haben viele Rahmenbedingungen für die Angehörigenbegleitung geändert und so die Betreuung von Angehörigen schwieriger gemacht.

Ziel

Ziel der Publikation ist die Darstellung der aktuellen und neuen Entwicklungen in der Angehörigenbegleitung von kritisch Kranken auf Intensivstationen im Rahmen einer narrativen Übersichtsarbeit.

Ergebnisse

In den letzten Jahren wurden zahlreiche Maßnahmen und Projekte zur Angehörigenbegleitung entwickelt, die sich den folgenden 6 Bereichen zuordnen lassen: 1) Anwesenheit der Angehörigen, 2) proaktive Einbindung in die Betreuung, 3) strukturierte Kommunikation und Information sowie Onlineangebote, 4) multidisziplinäre Zusammenarbeit, 5) Aufgaben der Organisationsleitung und 6) Follow-up-Angebote. Die Evidenz und der derzeitige Implementierungsstand der Maßnahmen sind international und national sehr heterogen.

Schlussfolgerungen

Maßnahmen zur Angehörigenbetreuung sind vielfältig und können zum Teil auch unter Besuchsrestriktionen umgesetzt werden. Neuere Entwicklungen im digitalen Bereich ermöglichen zunehmend auch virtuelle Besuche und einen ergänzenden Informationsaustausch zwischen dem Team der ICU und den Angehörigen.

Major Impact of Coping Styles on Anxiety and Depression Symptoms in Healthcare Workers During the Outbreak of COVID-19

Background

In the early days of COVID-19 outbreak, the normally orderly health system was severely challenged by large numbers of feverish patients and shortage of healthcare workers. The outbreak played a harmful role in the mental health of these healthcare workers.

Objective

We aim to assess the prevalence of moderate or severe anxiety and depression symptoms (ADSs) of healthcare workers in different regions during COVID-19 disaster and identify the potential risk factors.

Methods

We did a cross-sectional study on ADS of healthcare workers in epicenter-Hubei province and regions in lower epidemic-other provinces by questionnaire online. The data of ADS, the demographic characteristics, occupational exposure, physical condition, family situation, and coping styles were collected and analyzed.

Results

A total of 24.68% of the respondents had experienced moderate or severe ADS. Moderate or severe ADSs were in a higher prevalence in Hubei (32.39%) than other provinces (18.22%). Suspicious symptoms on their own and in family members were independent risk factors of moderate or severe ADS of all health workers. Working on the frontline was the independent risk factor for participants in Hubei province, whereas quarantine was the independent risk factor for those in other provinces. Moreover, among all participants, those with negative coping style were more than four times more likely to have moderate or severe ADS than those with positive coping style.

Conclusion

Moderate or severe ADSs were in a higher prevalence in healthcare workers of Hubei province during COVID-19 outbreak. The coping style may have major impact on ADS in such situation.

Anxiety and Depression in the Relatives of COVID-19 and Non-COVID-19 Intensive Care Patients During the Pandemic

Background and aim

In the literature, there is no study on the anxiety and depression status of the relatives of intensive care COVID-19 and non-COVID-19 patients during the pandemic period. In this study, we aimed to compare the risk of developing anxiety and depression in the relatives of COVID-19 and non-COVID-19 intensive care patients during the pandemic, and also to determine the factors that may cause anxiety and depression.

Materials and methods

Relatives of patients admitted to Ankara City Hospital COVID-19 (n=45) and non-COVID-19 (n=45) intensive care units between 15 May and 31 July 2021 were included in this prospective study. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered to the relatives of the patients within the first 48 hours of their admission to the intensive care unit. The answers were recorded and HADS, HADS-A (anxiety) and HADS-D (depression) scores were calculated accordingly. Demographics, education and marital statuses of both the patients and their relatives were recorded. Logistic regression analysis was performed to determine the factors associated with depression and anxiety. Receiver operator characteristics (ROC) curves were drawn for the factors affecting depression and anxiety, and the area under the curve values were calculated.

Results

Demographics, APACHE II score, and patient affiliation were similar in both groups. The mean HADS scores of the relatives of COVID-19 and non-COVID-19 patients were 24.76 and 16.04 (p<0.001). The mean HADS-A scores were 12.89 and 7.78 (p<0.001), and the mean of HADS-D scores were 11.87 and 8.27 (p=0.001). Moderate and high-risk anxiety and depression were significantly higher in relatives of COVID-19 patients (p=0.018, p=0.001, respectively). The area under curve (AUC) values were 0.727 in the ROC curve plotted for the independent risk factor Q3 responses that reduced anxiety, and 0.791 and 0.785 in the ROC curve drawn for the independent risk factor Q1 and Q3 responses that reduced the development of depression.

Conclusion

We found that the anxiety and depression risk of the relatives of COVID-19 patients in the intensive care unit during the pandemic period is significantly higher than the relatives of non-COVID-19 patients in the intensive care unit. In addition, regardless of the diagnosis, younger intensive care patients may increase the anxiety and depression of the relatives of the patients during the pandemic. The higher-education level of the relatives of patients was determined as a factor reducing anxiety and depression.

The effect of structured virtual patient visits (sVPVs) on COVID-19 patients and relatives' anxiety levels in intensive care unit

AIM AND OBJECTIVES

To determine the effect of structured Virtual Patient Visits (sVPVs) on the anxiety, satisfaction, hospital anxiety and depression levels of intensive care unit (ICU) COVID-19 patients and their relatives.

BACKGROUND

There is no evidence regarding the direct effect of virtual patient visits in the ICU.

DESIGN

The STROBE statement guided this study. This investigator-initiated, prospective and single-centre study included COVID-19 patients and their relatives in an adult ICU between July and December 2020. We implemented daily sVPVs between all patients and their relatives. The study's primary outcome was the daily anxiety levels of patients and relatives immediately before and after sVPVs. The secondary outcomes were as follows: 1) hospital anxiety (HADS-A) and depression (HADS-D) levels during admission to and after discharge from the ICU and 2) satisfaction levels regarding the ICU and sVPVs of patients' relatives.

RESULTS

A total number of 301 daily sVPVs were conducted between 50 patients and their relatives. There was a significant difference between daily anxiety levels before and after sVPVs in both patients (2.97 vs. 1.49) and their relatives (5.70 vs. 3.53; p > .05). Whereas the anxiety levels of patients with basic face or high flow nasal cannula and non-invasive mechanical ventilation decreased statistically significantly more than those with IMV after a sVPV (p < .001), there was not a significant difference in decreased anxiety levels of patients' relatives according to the type of respiratory support provided to the patient (p > .05). HADS-A levels of relatives decreased statistically significantly after discharge/death. There was no statistically significant difference in HADS-A and HADS-D levels after discharge/death between the relatives of patients who died or did not die (p > .05). Furthermore, the overall ICU satisfaction rates were statistically significantly lower in relatives of patients who died than those who did not die (p < .05).

CONCLUSION

Regardless of whether the patients were intubated, sVPVs reduced the anxiety levels of all patients and relatives. The sVPV programme offered emotional support to patients and family members, with high levels of satisfaction, as well as provided regular informative updates and the opportunity for daily visits or final goodbyes.

RELEVANCE FOR CLINICAL PRACTICE

The sVPV programme is essential for all ICUs during the COVID-19 pandemic.

The impact of patient delirium in the intensive care unit: patterns of anxiety symptoms in family caregivers

BACKGROUND

The purpose of this study was to examine the association of patient delirium in the intensive care unit (ICU) with patterns of anxiety symptoms in family caregivers when delirium was determined by clinical assessment and family-administered delirium detection.

METHODS

In this cross-sectional study, consecutive adult patients anticipated to remain in the ICU for longer than 24 h were eligible for participation given at least one present family caregiver (e.g., spouse, friend) provided informed consent (to be enrolled as a dyad) and were eligible for delirium detection (i.e., Richmond Agitation-Sedation Scale score ≥ - 3). Generalized Anxiety Disorder-7 (GAD-7) was used to assess self-reported symptoms of anxiety. Clinical assessment (Confusion Assessment Method for ICU, CAM-ICU) and family-administered delirium detection (Sour Seven) were completed once daily for up to five days.

RESULTS

We included 147 family caregivers; the mean age was 54.3 years (standard deviation [SD] 14.3 years) and 74% (n = 129) were female. Fifty (34% [95% confidence interval [CI] 26.4-42.2]) caregivers experienced clinically significant symptoms of anxiety (median GAD-7 score 16.0 [interquartile range 6]). The most prevalent symptoms of anxiety were "Feeling nervous, anxious or on edge" (96.0% [95%CI 85.2-99.0]); "Not being able to stop or control worrying" (88.0% [95%CI 75.6-94.5]; "Worrying too much about different things" and "Feeling afraid as if something awful might happen" (84.0% [95%CI 71.0-91.8], for both). Family caregivers of critically ill adults with delirium were significantly more likely to report "Worrying too much about different things" more than half of the time (CAM-ICU, Odds Ratio [OR] 2.27 [95%CI 1.04-4.91]; Sour Seven, OR 2.28 [95%CI 1.00-5.23]).

CONCLUSIONS

Family caregivers of critically ill adults with delirium frequently experience clinically significant anxiety and are significantly more likely to report frequently worrying too much about different things. Future work is needed to develop mental health interventions for the diversity of anxiety symptoms experienced by family members of critically ill patients.

TRIAL REGISTRATION

This study is registered on ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT03379129 ).

Does hospitalisation of a patient in the intensive care unit cause anxiety and does restriction of visiting cause depression for the relatives of these patients during COVID-19 pandemic?

OBJECTIVES

During the pandemic, anxiety and depression may occur increasingly in the whole society. The aim of this study was to evaluate the possible cause, incidence and levels of anxiety and depression in the relatives of the patients in the intensive care unit (ICU) in accordance with the patients' SARS-CoV-2 polymerase chain reaction (PCR) result.

MATERIALS AND METHOD

The study was prospectively conducted on relatives of patients admitted to tertiary intensive care units during COVID-19 pandemic. Sociodemographic characteristics of the patients and their relatives were recorded. "The Turkish version of the Hospital Anxiety and Depression Scale" was applied twice to the relatives of 120 patients to determine the symptoms of anxiety and depression in accordance with the PCR results of the patients (PCR positive n = 60, PCR negative n = 60).

RESULTS

The ratios above cut-off values for anxiety and depression among relatives of the patients were 45.8% and 67.5% for the first questionnaire and 46.7% and 62.5% for the second questionnaire, respectively. The anxiety and depression in the relatives of PCR-positive patients was more frequent than the PCR negative (P < .001 for HADS-A and P = .034 for HADS-D). The prevalence of anxiety and depression was significantly higher in female relatives (P = .046 for HADS-A and P = .009 for HADS-A). There was no significant correlation between HADS and age of the patient or education of the participants. The fact that the patients were hospitalised in the ICU during the pandemic was an independent risk factor for anxiety (AUC = 0.746) while restricted visitation in the ICU was an independent risk factor for depression (AUC = 0.703).

CONCLUSION

Positive PCR and female gender were associated with both anxiety and depression while hospitalisation in the ICU due to COVID-19 was an independent risk factor for anxiety and restricted visitation in the ICU is an independent risk factor for depression.

Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review

AIMS AND OBJECTIVES

To map research-based psychological distress among the family members with patients in the intensive care unit (ICU).

BACKGROUND

Having a loved one in the ICU is a stressful experience, which may cause psychological distress for family members. Depression, anxiety and stress are the common forms of psychological distress associated with ICU patient's family members. Directly or indirectly, psychological distress may have behavioural or physiological impacts on the family members and ICU patient's recovery.

DESIGN

The study was based on the five-stage methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) and were guided by the PRISMA-ScR Checklist.

METHODS

A comprehensive and systematic search was performed in five electronic databases, namely the Scopus, Web of Sciences, CINAHL^® Complete @EBSCOhost, ScienceDirect and MEDLINE. Reference lists from the screened full-text articles were reviewed.

RESULTS

From a total of 1252 literature screened, 22 studies published between 2010-2019 were included in the review. From those articles, four key themes were identified: (a) Prevalence of psychological distress; (b) Factors affecting family members; (c) Symptoms of psychological distress; and (d) Impact of psychological distress.

CONCLUSIONS

Family members with a critically ill patient in ICU show high levels of anxiety, depression and stress. They had moderate to major symptoms of psychological distress that negatively impacted both the patient and family members.

RELEVANCE TO CLINICAL PRACTICE

The review contributed further insights on psychological distress among ICU patient's family members and proposed psychological interventions that could positively impact the family well-being and improve the patients' recovery.

Psychological responses and coping behaviour of visiting family members during and following unplanned hospital admission

AIMS

To describe the psychological symptoms and coping behaviours of visiting family members following the unplanned hospitalisation of their relative.

BACKGROUND

Hospitalisation of a patient is recognised as a stressful time for visiting family members, who experience psychological morbidity and elevated health risk.

DESIGN

This prospective longitudinal evaluation included 40 family members of patients with unplanned admission to coronary or intensive care. Assessments were conducted at 3 timepoints: in-hospital within 1 week of admission and again at 2 weeks and 3 months post-discharge. Measures included symptoms of anxiety, depression, and anger, coping strategies and social support. This paper adhered to STROBE guidelines.

RESULTS

At the initial in-hospital assessment study participants reported higher anxiety, depression and anger symptoms levels compared to community matched control participants. Compared to in-hospital assessment, anxiety and depression levels were lower at 2 weeks and 3 months following hospital discharge. The use of active coping and the use of religion during early hospitalisation were associated with higher anxiety and depression symptoms at 3 months post-discharge. Conversely, use of instrumental support (getting help and advice from others), planning and venting during early hospitalisation were associated with lower depression symptoms at 3 months. Venting during the hospitalisation period was also associated with lower anxiety symptoms at 3 months.

CONCLUSION

Results demonstrate the significant psychological impact of unplanned hospitalisation on visiting family members both during and following hospitalisation. The finding that prolonged psychological response is associated with individual coping strategies employed in the early hospitalised period informs potential preventative approaches for family members at risk of prolonged psychological morbidity following hospitalisation of their loved one.

RELEVANCE TO CLINICAL PRACTICE

The reported psychological impact of hospitalisation on family members provides a strong imperative for nurses and health professionals to provide early individualised support to reduce the risk of long-term psychological morbidity.

Factors influencing post-ICU psychological distress in family members of critically ill patients: a linear mixed-effects model

BACKGROUND

Adverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients.

METHODS

We conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first 3 months after their close other's ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures.

RESULTS

A total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression, and patient death was associated with higher levels of depression and posttraumatic stress.

CONCLUSIONS

Our results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance.

Psychological effects of remote-only communication among reference persons of ICU patients during COVID-19 pandemic

Background

During COVID-19 pandemic, visits have been prohibited in most French ICUs. Psychological effects, for reference persons (RPs), of remote-only communication have been assessed.

Methods

All RPs of patients referred to ICU for COVID-19 were included. HADS, IES-R, and satisfaction were evaluated at admission, discharge/death, and 3 months. At 3 months, a psychologist provided a qualitative description of RPs’ psychological distress.

Results

Eighty-eight RPs were included. Prevalence of anxiety and depression was 83% and 73% respectively. At 3 months, lower HADS decrease was associated with patient death/continued hospitalization, and/or sleeping disorders in RPs (p < 0.01). Ninety-nine percent RPs felt the patient was safe (9 [7; 10]/10 points, Likert-type scale), confident with caregivers (10 [9; 10]/10 points), and satisfied with information provided (10 [9; 10]/10 points). All RPs stressed the specific-type of “responsibility” associated with being an RP in a remote-only context, leading RPs to develop narrow diffusion strategies (67%) and restrict the array of contacted relatives to a very few and/or only contacting them rarely. 10 RPs (30%) related the situation to a prior traumatic experience.

Conclusion

RPs experienced psychological distress and reported that being an RP in a remote-only communication context was a specific responsibility and qualified it as an overall negative experience.

Trial registration

NCT04385121. Registered 12 May 2020. https://clinicaltrials.gov/.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40560-020-00520-w.

Psychological Sequelae in Family Caregivers of Critically III Intensive Care Unit Patients. A Systematic Review

Rationale: Family members of critically ill patients hospitalized in the intensive care unit (ICU) often become caregivers, and they are at risk to develop adverse psychological outcomes. There is a need to understand the psychological impact of critical illness on family caregivers. Objectives: The aim of this systematic review is to document the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) in family caregivers of critically ill patients and identify potential risk factors for psychological outcomes to inform clinical and future research recommendations. Methods: A literature search for psychological outcomes for family caregivers of critically ill patients was conducted. A total of 1,148 studies from PsycINFO, CINAHL, Web of Science, SCOPUS, and Medline were identified. Results: Forty studies met inclusion criteria and were included in the review. The prevalence of psychological outcomes in family caregivers ranged from 4% to 94% for depression, 2% to 80% for anxiety, and 3% to 62% for PTSD. Caregiver depression, anxiety, and PTSD decreased in most studies that assessed longitudinal outcomes. Common risk factors identified for adverse psychological outcomes included younger caregiver age, caregiver relationship to the patient, lower socioeconomic status, and female sex. Conclusions: The prevalence of depression, anxiety, and PTSD varies greatly across studies of family caregivers of critically ill patients. This finding highlights the need for more systematic investigations of psychological outcomes and the implementation of clinical interventions to prevent or reduce depression, anxiety, and PTSD in family caregivers of critically ill patients.

Family members' experiences in adult intensive care units: a systematic review

BACKGROUND

Admission to Intensive Care Units (ICU) exposures family members to a new environment, advanced monitoring systems and aggressive treatments. This is coupled with the critical condition of the patient being admitted in ICU. In such times of stress and crisis, families have varying experiences as they navigate the ICU journey. These happen more or less in chronological phases.

AIM

This review sought to describe the experiences of family members of patients admitted in adult ICUs.

DATA SOURCES

Four electronic databases (PubMed, Embase, Scopus and Web of Science) were searched, using keywords and free-text words.

METHODS

Curation of the review question involved problem identification, a scoping search, developing a search strategy, evaluation, data analysis, and reporting. Freehand search in reference lists of eligible articles was also done to obtain potentially eligible articles published in English language between 2007 and 2018. Studies were included if they reported on family members' experiences in adult ICUs. This review conforms to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA).

RESULTS

Upon completion of the screening process, 28 studies were included. Most studies were conducted in the United States while no study was identified from Africa. We report on 717 family members. Family members' experience of the ICU journey falls into three main themes: (i) Floating, (ii) Probing and (iii) Continuity or Closure.

CONCLUSION

As healthcare technology advances, the ICU environment consequently needs to evolve. As such, healthcare providers will need to adjust their practice, support and consider the patients' family as the other part of the patient and members of the care team in order to meet their expectations. Further research highlighting family members' experience of the ICU journey in Africa is needed.

Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: age matters

Background

Survivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their partners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using appropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and controlling for contextual factors, is lacking.

Methods

The present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the health-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-Interdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The Post-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their partners, within up to 6 months after the transfer from acute care ICU to post-acute ICU.

Results

Clinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of the partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress symptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners compared to female partners or female patients. In younger partners (≤ 57 years), higher values of post-traumatic stress symptoms were associated with a decreased QoL in the patients.

Conclusions

Mental health screening and psychotherapeutic treatment options should be offered to both the chronically critically ill patients and their partners. Future research is required to address the special needs of younger patient-partner dyads, following protracted ICU treatment.

Trial registration

German Clinical Trials Register No. DRKS00003386. Registered 13 November 2011

Electronic supplementary material

The online version of this article (10.1186/s13054-019-2321-0) contains supplementary material, which is available to authorized users.

The health promoting conversations intervention for families with a critically ill relative: A pilot study

BACKGROUND

After intensive care unit treatment, patients often have prolonged impairments that affect their physical, cognitive and mental health. Family members can face overwhelming and emotionally challenging situations and their concerns and needs must be addressed.

OBJECTIVE

We investigated the outcomes of pilot randomised control trial, a nurse-led family intervention, Health Promoting Conversations, which focused on family functioning and wellbeing in families with a critically ill member.

STUDY DESIGN

This randomised controlled pilot study used a pre-test, post-test design with intervention and control groups to investigate the outcomes of the nurse-led intervention in 17 families.

OUTCOME MEASURES

The Health Promoting Conversations intervention was evaluated using validated instruments that measure family functioning and family wellbeing: the General Functioning sub-scale from the McMaster Family Assessment Device; the Family Sense of Coherence, the Herth Hope Index, and the Medical Outcome Short-Form Health Survey. Descriptive and analytical statistical methods were used to analyse the data.

RESULTS

After 12 months, the intervention group reported better family functioning than the control group. The intervention group also had better social functioning and mental health after 12 months.

CONCLUSION

This intervention may improve family wellbeing by improving family function, reducing stress, and promoting better mental health.

Family-centered outcomes during and after critical illness: current outcomes and opportunities for future investigation

PURPOSE OF REVIEW

Family-centered outcomes during and after critical illness assess issues that are most important to family members. An understanding of family-centered outcomes is necessary to support the provision of family-centered care and to foster development of interventions to improve care and communication in the ICU.

RECENT FINDINGS

Current family-centered outcomes in critical care include satisfaction with care, including end-of-life care, symptoms of psychological distress, and health-related quality of life. Novel measures include assessments of decisional conflict, decision regret, therapeutic alliance, and caregiver burden, as well as positive adaptations and resilience.

SUMMARY

Critical illness places a significant burden on family members. A wide variety of family-centered outcomes are available to guide improvements in care and communication. Future research should focus on developing sensitive and responsive measures that capture key elements of the family member experience during and after critical illness.