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Pant U, Vyas K, Meghani S, Park T, Norris CM, Papathanassoglou E. Screening tools for post-intensive care syndrome and post-traumatic symptoms in intensive care unit survivors: A scoping review. Aust Crit Care 2023; 36:863-871. [PMID: 36464526 DOI: 10.1016/j.aucc.2022.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post-intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life. OBJECTIVES We aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies. METHOD A scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines. FINDINGS We identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools. CONCLUSION These results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge.
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Affiliation(s)
- Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Krooti Vyas
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Shaista Meghani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Tanya Park
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Colleen M Norris
- Professor, Faculty of Nursing, Scientific Director, Cardiovascular Health and Stroke Strategic Clinical Network, Adjunct Professor Faculty of Medicine & Dentistry and School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Elizabeth Papathanassoglou
- Professor, Faculty of Nursing, University of Alberta, Scientific Director, Neurosciences Rehabilitation & Vision Strategic Clinical Network™ Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada.
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Engwall M, Jutengren G, Bergbom I, Lindahl B, Fridh I. Patients' Self-Reported Recovery After an Environmental Intervention Aimed to Support Patient's Circadian Rhythm in Intensive Care. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:194-210. [PMID: 33754878 PMCID: PMC8597201 DOI: 10.1177/19375867211001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients in intensive care units (ICUs) are among the most vulnerable, and they require support to start their recovery. The design of the patient area in the ICU can play a prominent role in both the quality of care and patients' recovery. The lighting environment has the opportunity to restore and strengthen the natural human circadian rhythm and health. AIM To evaluate patients' self-reported recovery after being cared for in an ICU room rebuilt according to evidence-based design principles that promote recovery. METHOD An intervention was set up in a two-bed patient room including a cycled lighting system. Self-reported recovery was reported at 6 and 12 months after discharge. Data were analyzed using a 2(mechanically ventilated, nonmechanically ventilated) × 2(intervention room, ordinary room) analysis of covariance (ANCOVA) and 2(male, women) × 2(intervention room, ordinary room) ANCOVA. RESULTS Data from the different rooms showed no significant main effects for recovery after 6 months, p = .21; however, after 12 months, it become significant, p. < .05. This indicated that patient recovery was positively influenced for patients cared for in the intervention room (M = 8.88, SD = 4.07) compared to the ordinary room (M = 10.90, SD = 4.26). There were no interaction effects for gender or if the patients had been mechanically ventilated either at 6 or 12 months' postdischarge. CONCLUSIONS A cycled lighting system may improve patient self-reported recovery after ICU care; however, more research on the topic is needed.
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Affiliation(s)
- Marie Engwall
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Göran Jutengren
- Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Ingegerd Bergbom
- Institute of Health and Caring Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Berit Lindahl
- Department of Health Sciences, Faculty of Medicine, University of Lund, Sweden
| | - Isabell Fridh
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Sweden
- Department of Anesthesiology, Surgery, and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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O'Neill B, Linden M, Ramsay P, Darweish Medniuk A, Outtrim J, King J, Blackwood B. Development of the support needs after ICU (SNAC) questionnaire. Nurs Crit Care 2021; 27:410-418. [PMID: 34387920 PMCID: PMC9290803 DOI: 10.1111/nicc.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Abstract
Aims To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks, (3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post‐hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test–retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one‐way ANOVA. Results The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test–retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post‐hospital support services.
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Affiliation(s)
- Brenda O'Neill
- Centre for Health and Rehabilitation Technologies, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Mark Linden
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Pam Ramsay
- School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | | | - Joanne Outtrim
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Judy King
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK
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Alexandersen I, Haugdahl HS, Stjern B, Paulsby TE, Lund SB, Haugan G. 'I want to get back!' A qualitative study of long-term critically ill patients' inner strength and willpower: Back home after long-term intensive care. J Clin Nurs 2021; 30:3023-3035. [PMID: 34018274 DOI: 10.1111/jocn.15812] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To provide insights into what promotes and challenges inner strength and willpower in formerly critically ill patients back home after a long-term ICU stay. BACKGROUND Critically ill patients demand great resources during an ICU stay, some experience great challenges after discharge from hospital. Knowledge about how health professionals can promote former long-term critically ill patients' inner strength and willpower after discharge is essential, but still missing. DESIGN A qualitative, hermeneutic-phenomenological approach using in-depth interviews with former long-term ICU patients. METHODS Seventeen long-term ICU patients were interviewed 6-20 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (COREQ,2007). RESULTS Back home after hospital discharge, some former patients coped well while others suffered heavy burdens mentally and physically, along with economic problems. They handled their challenges differently: some found comfort and insight by reading their diary written by their ICU nurses, while several were struggling alone experiencing a lonesome silent suffering; these called for a follow-up support by the healthcare system. CONCLUSION Long-term ICU patients' inner strength and willpower are vital salutogenic resources supporting the fight back to one's former independent life. However, physical, mental and economic challenges drain their inner strength to go on and succeed. Several long-term ICU patients need health-promoting follow-up support after hospital discharge. RELEVANCE TO CLINICAL PRACTICE This study disclosed a lonely and silent suffering indicating a need for development of systematical health-promoting follow-up programmes including salutogenic components such as health-promoting conversations, diaries and web-based recovery programme along with a cell phone app.
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Affiliation(s)
- Ingeborg Alexandersen
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,St. Olav University Hospital, Trondheim, Norway
| | - Hege Selnes Haugdahl
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Berit Stjern
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Tove Engan Paulsby
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Stine Borgen Lund
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Gørill Haugan
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Halm MA. Intensive Care Unit Diaries, Part 2: Impact of Diaries and Follow-up Consultation on Post-Intensive Care Syndrome. Am J Crit Care 2019; 28:488-492. [PMID: 31676526 DOI: 10.4037/ajcc2019839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Margo A. Halm
- Margo A. Halm is associate chief nurse executive, nursing research and evidence-based practice, VA Portland HealthCare System, Portland, Oregon
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Linhares LMSD, Kawakame PMG, Tsuha DH, Souza ASD, Barbieri AR. Construction and validation of an instrument for the assessment of care provided to people with suicidal behavior. Rev Saude Publica 2019; 53:48. [PMID: 31066826 PMCID: PMC6536102 DOI: 10.11606/s1518-8787.2019053000888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/06/2018] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To develop and validate an instrument for evaluating primary health care professionals’ assistance to people with suicidal behavior. METHODS This was a methodological study, which began with a literature review, followed by the elaboration of an instrument. In its first version, the instrument had 34 items, divided into four domains: “professional characterization,” “professional perception ” “professional knowledge/abilities,” and “organization of the care network.” Contents were validated using the Delphi method. Semantic analysis was performed by college-educated primary health care professionals in greater and lesser strata of ability. For internal consistency analysis, Cronbach’s alpha coefficient was calculated. The study was conducted between January and December 2017. RESULTS After four Delphi rounds, the instrument was successfully validated. In its final form, it is comprised of 50 items, divided into five domains: “professional characterization,” “professional sensibility,” “professional experience,” “professional knowledge/abilities,” and “organization of the care network.” Questions belonging to the last four domains have answers on a five-point Likert scale. In the semantic analysis, 93.6% of the evaluations were “good” and “very good.” The instrument’s general Cronbach alpha was 0.90. CONCLUSIONS The final version of the instrument was able to fulfill its objectives. It is useful as a support for epidemiological research and planning of health actions. The evaluation of professional approaches to suicidal behavior is crucial for the organization of suicide assistance services in primary health care, and for the integration of services provided by different care units.
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Affiliation(s)
- Laura Maria Souza de Linhares
- Universidade Federal de Mato Grosso do Sul . Programa de Pós-Graduação em Saúde da Família . Campo Grande , MS , Brasil
| | - Patrícia Moita Garcia Kawakame
- Universidade Federal de Mato Grosso do Sul . Curso de Graduação em Enfermagem. Instituto Integrado em Saúde . Campo Grande , MS , Brasil
| | - Daniel Henrique Tsuha
- Secretaria de Estado de Saúde de Mato Grosso do Sul . Central Estadual de Regulação Assistencial . Campo Grande , MS , Brasil
| | | | - Ana Rita Barbieri
- Universidade Federal de Mato Grosso do Sul . Pró-Reitoria de Assuntos Estudantis. Campo Grande , MS , Brasil
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