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Riestra Guiance I, Wallace L, Varga K, Niven A, Hosey M, Chitulangoma J, Philbrick K, Gajic O, Weiman M, Schmitt E, Pasko D, Karnatovskaia L. Communication in the ICU: An Unintended Nocebo Effect? J Patient Exp 2024; 11:23743735241272148. [PMID: 39130130 PMCID: PMC11311157 DOI: 10.1177/23743735241272148] [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] [Indexed: 08/13/2024] Open
Abstract
To identify medical phrases utilized by the critical care team that may have an unintended impact on the critically ill patient, we administered an anonymous survey to multi-professional critical care team members. We elicited examples of imprecise language that may have a negative emotional impact on the critically ill. Of the 1600 providers surveyed, 265 offered 1379 examples (912 unique) which were clustered into 5 categories. Medical jargon (eg, "riding the vent") was most prevalent (n = 549). There were 217 negative suggestions (eg, "you will feel a stick and a burn"). Hyperboles (eg, "black cloud") were common (n = 198) while homonyms (ie "he fibbed") accounted for 150 examples. Phrases such as "code brown in there" were categorized as metonyms (n = 144). 121 metaphors/similes (eg, "rearranging deck chairs on the Titanic") were provided. Phrases that have the potential to negatively impact critically ill patient perceptions are commonplace in critical care practice. Whether these everyday communication habits lead to an unintended nocebo effect on mental health outcomes of the critically ill deserves further study.
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Affiliation(s)
| | - Lindsey Wallace
- Department of Critical Care Multidisciplinary Program, Mayo Clinic, Rochester, MN, USA
| | - Katalin Varga
- Department of Affective Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Alexander Niven
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Megan Hosey
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jillene Chitulangoma
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Kemuel Philbrick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Emily Schmitt
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - David Pasko
- Department of Respiratory Care, Mayo Clinic, Rochester, MN, USA
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Landbeck A, Witt A, Marty Petit E, Aebischer E, Poujol AL, Nguyen S, Simon E, Bernigaud P, Thiery G, Bouhemad B, Laurent A. What clinical practices for intensive care psychologists in France? A national survey. Crit Care 2024; 28:204. [PMID: 38902834 PMCID: PMC11188499 DOI: 10.1186/s13054-024-04987-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Alicia Landbeck
- Laboratoire Psy-DREPI, PSY-DREPI UR 7458, Université de Bourgogne Pôle AAFE, University of Burgundy, Esplanade Erasme, 21078, Dijon, France
| | - Arnaud Witt
- LEAD CNRS UMR 5022, University of Burgundy, Dijon, France
| | - Emilie Marty Petit
- Intensive Care Unit, Centre Hospitalier Intercommunal de Poissy and St Germain en Laye, Poissy, France
- Groupe Patient-Proche SRLF, Paris, France
| | - Emilie Aebischer
- Groupe Patient-Proche SRLF, Paris, France
- Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Anne-Laure Poujol
- École de Psychologues Praticiens, Institut Catholique de Paris, EA 7403, Paris, France
- Polyvalent Surgical Intensive Care Unit, Department of Anesthesia and Intensive Care, Hôpital de La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphanie Nguyen
- Laboratoire Psy-DREPI, PSY-DREPI UR 7458, Université de Bourgogne Pôle AAFE, University of Burgundy, Esplanade Erasme, 21078, Dijon, France
- Intensive Care Unit, Saint Antoine Hospital, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Etienne Simon
- Laboratory of Psychology, University of Franche-Comté, Besançon, France
| | - Pauline Bernigaud
- Laboratoire Psy-DREPI, PSY-DREPI UR 7458, Université de Bourgogne Pôle AAFE, University of Burgundy, Esplanade Erasme, 21078, Dijon, France
| | - Guillaume Thiery
- Groupe Patient-Proche SRLF, Paris, France
- Intensive Care Unit, CHU Saint Etienne, Saint-Étienne, France
| | - Belaid Bouhemad
- Department of Anesthesia and Intensive Care, CHU Dijon-Bourgogne, Dijon, France
| | - Alexandra Laurent
- Laboratoire Psy-DREPI, PSY-DREPI UR 7458, Université de Bourgogne Pôle AAFE, University of Burgundy, Esplanade Erasme, 21078, Dijon, France.
- Department of Anesthesia and Intensive Care, CHU Dijon-Bourgogne, Dijon, France.
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Tronstad O, Zangerl B, Patterson S, Flaws D, Yerkovich S, Szollosi I, White N, Garcia-Hansen V, Leonard FR, Weger BD, Gachon F, Brain D, Lavana J, Hodgson C, Fraser JF. The effect of an improved ICU physical environment on outcomes and post-ICU recovery-a protocol. Trials 2024; 25:376. [PMID: 38863018 PMCID: PMC11167845 DOI: 10.1186/s13063-024-08222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Intensive care medicine continues to improve, with advances in technology and care provision leading to improved patient survival. However, this has not been matched by similar advances in ICU bedspace design. Environmental factors including excessive noise, suboptimal lighting, and lack of natural lights and views can adversely impact staff wellbeing and short- and long-term patient outcomes. The personal, social, and economic costs associated with this are potentially large. The ICU of the Future project was conceived to address these issues. This is a mixed-method project, aiming to improve the ICU bedspace environment and assess impact on patient outcomes. Two innovative and adaptive ICU bedspaces capable of being individualised to patients' personal and changing needs were co-designed and implemented. The aim of this study is to evaluate the effect of an improved ICU bedspace environment on patient outcomes and operational impact. METHODS This is a prospective multi-component, mixed methods study including a randomised controlled trial. Over a 2-year study period, the two upgraded bedspaces will serve as intervention beds, while the remaining 25 bedspaces in the study ICU function as control beds. Study components encompass (1) an objective environmental assessment; (2) a qualitative investigation of the ICU environment and its impact from the perspective of patients, families, and staff; (3) sleep investigations; (4) circadian rhythm investigations; (5) delirium measurements; (6) assessment of medium-term patient outcomes; and (7) a health economic evaluation. DISCUSSION Despite growing evidence of the negative impact the ICU environment can have on patient recovery, this is an area of critical care medicine that is understudied and commonly not considered when ICUs are being designed. This study will provide new information on how an improved ICU environment impact holistic patient recovery and outcomes, potentially influencing ICU design worldwide. TRIAL REGISTRATION ACTRN12623000541606. Registered on May 22, 2023. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385845&isReview=true .
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Barbara Zangerl
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Irene Szollosi
- Sleep Disorders Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Nicole White
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Veronica Garcia-Hansen
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Francisca Rodriguez Leonard
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Benjamin D Weger
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Frédéric Gachon
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - David Brain
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Jayshree Lavana
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Division of Clinical Trial and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Physiotherapy Department, Alfred Hospital, Melbourne, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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He X, Song Y, Cao Y, Miao L, Zhu B. Post intensive care syndrome: A review of clinical symptoms, evaluation, intervention. Heliyon 2024; 10:e31278. [PMID: 38803859 PMCID: PMC11128526 DOI: 10.1016/j.heliyon.2024.e31278] [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: 10/21/2023] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
Post intensive care syndrome (PICS) is a typical complication of critically ill patients during or after their stay in intensive care unit (ICU), characterized by a high incidence and impairment rate. It significantly impacts the quality of life of patients and their families, as well as consumes a substantial amount of medical resources. Therefore, early intervention and assessment of PICS is crucial. This paper aims to provide clinical professionals with a reference base by focusing on the clinical symptoms, diagnostic assessment, and preventative measures of PICS.
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Affiliation(s)
- Xiaofang He
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuwei Song
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuchun Cao
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Liying Miao
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, Changzhou, 213000, Jiangsu, China
| | - Bin Zhu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
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Ageel M, Shbeer A, Tawhari M, Darraj H, Baiti M, Mobaraki R, Hakami A, Bakri N, Almahdi RH, Ageeli R, Mustafa M. Prevalence of Depression, Anxiety, and Post-traumatic Stress Syndrome Among Intensive Care Unit Survivors in Jazan, Saudi Arabia. Cureus 2024; 16:e60523. [PMID: 38883092 PMCID: PMC11180542 DOI: 10.7759/cureus.60523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To quantify the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) among ICU survivors in the Jazan region, Saudi Arabia, and explore the correlational relationships among these conditions to inform targeted mental health interventions in this unique regional context. Methods The study employed a cross-sectional observational design to assess ICU survivors from two major hospitals in the Jazan Region: Prince Mohammed Bin Nasser Hospital and King Fahad Central Hospital. One hundred participants were interviewed face-to-face to gather detailed insights into their post-ICU experiences. We employed the hospital anxiety and depression scale (HADS) and the post-trauma symptom scale (PTSS-10) to systematically assess the psychological impacts of anxiety, depression, and PTSD among participants. Results The demographic breakdown of participants showed a youthful skew, with 37% under 35 years, 49% aged between 36-60 years, and only 14% over 60 years, contrasting with typical ICU demographics, which generally skew older. This younger distribution may influence the psychological outcomes observed. The sample was fairly gender-balanced, with 53% male and 47% female, closely reflecting the regional gender ratio of ICU admissions. Among the participants, 24% were classified as 'abnormal' and 20% as 'borderline abnormal' for anxiety, while 25% were 'borderline abnormal' and 21% 'abnormal' for depression. About 8% of participants were diagnosed with severe PTSD. Anxiety was more strongly correlated with PTSD than depression. The analysis demonstrated significant associations between demographic factors and psychological distress among ICU survivors. Females reported higher anxiety, while lower education and unemployment were associated with increased depression. Additionally, lower household income was associated with higher PTSS scores, and marital status was linked to depression, suggesting that socioeconomic factors play a critical role in post-ICU psychological recovery. Conclusion The findings emphasize the imperative need for comprehensive mental health evaluations and tailored interventions for ICU survivors in the Jazan region.
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Affiliation(s)
- Mohammed Ageel
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Abdullah Shbeer
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Mariam Tawhari
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Hussam Darraj
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Maisa Baiti
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Raghad Mobaraki
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Areej Hakami
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Nawaf Bakri
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Rahf H Almahdi
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Raghd Ageeli
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Mawada Mustafa
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
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Du Z, Liu X, Li Y, Wang L, Tian J, Zhang L, Yang L. Depressive symptoms over time among survivors after critical illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 87:41-47. [PMID: 38306945 DOI: 10.1016/j.genhosppsych.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Critical illness survivors frequently experience various degrees of depressive symptoms, which hinder their recovery and return to daily life. However, substantial variability in the prevalence of depressive symptoms has been reported among critical illness survivors. The exact prevalence remains uncertain. METHODS A systematic search was performed in PubMed, Embase, CINAHL, and PsycINFO from inception to August 2023 for observational studies that reported depressive symptoms in adult critical illness survivors. The random-effects model was used to estimate the prevalence of depressive symptoms. Subgroup analysis and meta-regression were conducted to explore potential moderators of heterogeneity. Study quality was evaluated using the Joanna Briggs Institute's tool and the GRADE approach. RESULTS Fifty-two studies with 24,849 participants met the inclusion criteria. Overall prevalence estimate of depressive symptoms was 21.1% (95% CI, 18.3-24.1%). The prevalence of depressive symptoms remains stable over time. Point prevalence estimates were 21.3% (95% CI, 9.9-35.4%), 19.9% (95% CI, 14.6-25.9%), 18.5% (95% CI, 9.6-29.2%), 21.0% (95% CI, 16.8-25.5%), and 22.6% (95% CI, 14.4-31.8%) at <3, 3, 6, 12, and > 12 months after discharge from intensive care unit (ICU), respectively. CONCLUSIONS Depressive symptoms may impact 1 in 5 adult critically ill patients within 1 year or more following ICU discharge. An influx of rehabilitation service demand is expected, and risk stratification to make optimal clinical decisions is essential. More importantly, to propose measures for the prevention and improvement of depressive symptoms in patients after critical care, given the continuous, dynamic management of ICU patients, including ICU stay, transition to general wards, and post-hospital.
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Affiliation(s)
- Zhongyan Du
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Xiaojun Liu
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Yuanyuan Li
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China
| | - Lina Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Jiaqi Tian
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Ling Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China
| | - Lijuan Yang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250000, China; Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China.
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Abdelbaky AM, Eldelpshany MS. Intensive Care Unit (ICU)-Related Post-traumatic Stress Disorder: A Literature Review. Cureus 2024; 16:e57049. [PMID: 38681363 PMCID: PMC11046361 DOI: 10.7759/cureus.57049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
An intensive care unit (ICU) is a challenging environment characterized by frequent incidences of stressors and traumatic situations. Therefore, both patients and caregivers are at high risk of developing psychological disorders such as post-traumatic stress disorder (PTSD), anxiety, and depression. ICU-related PTSD is a significant concern that remains under-recognized. This literature review examines the current state of knowledge regarding ICU-related PTSD, including its prevalence, risk factors, clinical manifestations, and potential interventions. Key findings suggest that a considerable proportion of ICU survivors develop PTSD symptoms, which can significantly impact their quality of life and recovery. The most common predictors investigated for PTSD in ICU survivors are age, gender, pre-illness psychopathy, length of stay in the ICU, delirium, and sedative agents. The treatment and prevention strategies of ICU-related PTSD include psychological therapies and pharmacological and non-pharmacological treatments. Psychological interventions, including cognitive-behavioral therapy and pharmacotherapy, have shown promise in mitigating PTSD symptoms in ICU survivors. However, further research is needed to better understand the mechanisms underlying ICU-related PTSD and to develop targeted interventions to prevent and manage this debilitating condition.
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Matsuishi Y, Hoshino H, Enomoto Y, Shimojo N, Ikeda M, Kotani M, Kobayashi S, Kido T, Mathis BJ, Nakamura K, Nakano H, Okubo N, Inoue Y. Verifying the Japanese version of the Healthy Aging Brain Care Monitor self-report tool for evaluating post-intensive care syndrome. Aust Crit Care 2023; 36:989-996. [PMID: 36934045 DOI: 10.1016/j.aucc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/17/2023] [Accepted: 02/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Post-intensive care syndrome (PICS) requires the use of multiple assessment tools because it affects multiple domains: Cognitive, Functional, and Behavioural/Psychological. Therefore, this study translated the self-report (SR) version of the Healthy Aging Brain Care Monitor (HABC-M), spanning multiple domains, into Japanese and analysed its reliability and validity in a post-intensive care setting. METHODS Patients aged 20 years or older and admitted to the adult intensive care unit from August 2019 to January 2021 were included and surveyed by questionnaire. The 21-item Dementia Assessment Sheet for the Regional Comprehensive Care System was used to validate cognitive and physical aspects, and the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Post Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5th edition were used to validate emotional aspects. Reliability was assessed by Cronbach's alpha, and congruent validity by correlation analysis. Multivariate linear regression models were used to identify potential factors for PICS. RESULTS A total of 104 patients (mean age: 64 ± 14 years) with 3 median mechanical ventilation days (interquartile range: 2-5) were enrolled. The Cognitive domain of the HABC-M SR was highly correlated with memory and disorientation (r = 0.77 for each), while the Functional domain was highly correlated with Instrumental Activities of Daily Living Scale (r = 0.75-0.79). The Behavioural/Psychological domain highly correlated with the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Post Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5th edition (r = 0.75-0.76). Multivariate analysis revealed longer ICU stays associated with lower Cognitive and Functional (p = 0.03 for each) domains and longer mechanical ventilation days with a lower Behavioural/Psychological domain (p < 0.01). CONCLUSION The translated Japanese HABC-M SR showed high validity for assessment of the Cognitive, Functional, and Behavioural/Psychological domains of PICS. Therefore, we recommend that the Japanese version of the HABC-M SR be routinely used in the assessment of PICS.
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Affiliation(s)
- Yujiro Matsuishi
- Neuroscience Nursing, St. Luke's International University, Tokyo, Japan.
| | - Haruhiko Hoshino
- Adult Health Nursing, Department of Nursing, International University of Health and Welfare, Narita, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; University of Tsukuba Hospital, Department of Pediatrics, Tsukuba, Ibaraki, Japan
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mitsuki Ikeda
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Misaki Kotani
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shunsuke Kobayashi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Kido
- University of Tsukuba Hospital, Department of Pediatrics, Tsukuba, Ibaraki, Japan
| | - Bryan J Mathis
- Medical English Communication Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan
| | - Hidehiko Nakano
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan
| | - Nobuko Okubo
- Neuroscience Nursing, St. Luke's International University, Tokyo, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Bjørnøy I, Rustøen T, Mesina RJS, Hofsø K. Anxiety and depression in intensive care patients six months after admission to an intensive care unit: A cohort study. Intensive Crit Care Nurs 2023; 78:103473. [PMID: 37354695 DOI: 10.1016/j.iccn.2023.103473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES To measure the prevalence of anxiety and depression in intensive care patients six months after admission to an intensive care unit and to investigate which variables are associated with anxiety and depression at six months. RESEARCH METHODOLOGY In this cohort study, patient-reported outcome measures were collected as soon as possible upon admission and at six months. Two logistic regression models were performed to examine variables associated with reporting anxiety and depression above ≥8 at six months. SETTING Patients were recruited from six intensive care units in two Norwegian hospitals between 2018 and 2020. MAIN OUTCOME MEASURES The Hospital Anxiety and Depression Scale. RESULTS A total of 145 patients was included in the study. The patients reported a prevalence of 18.6% (n = 27) and 12.4% (n = 18) of anxiety and depression, respectively. Higher baseline anxiety scores were associated with both higher odds of reporting anxiety and depression above ≥8. Younger age was associated with higher odds of reporting anxiety, and being female was associated with lower odds of reporting depression. CONCLUSION Several intensive care survivors reported having symptoms of anxiety and depression six months after admission to the intensive care unit. Younger age, and higher anxiety scores at baseline were variables associated with higher odds of reporting symptoms of either anxiety or depression, while being female was associated with a lower odds of reporting depression. IMPLICATIONS FOR CLINICAL PRACTICE Screening patients for anxiety and depression may help to identify vulnerable patients. Structured follow-ups with intensive care nurses in an outpatient setting may be useful to help patients to work through some of the experiences from the intensive care unit.
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Affiliation(s)
- Ingrid Bjørnøy
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Lovisenberg gt 15b, N-0456 Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, NO-0316 Oslo, Norway.
| | - Renato Jr Santiago Mesina
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.
| | - Kristin Hofsø
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Lovisenberg gt 15b, N-0456 Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.
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Ait Hssain A, Farigon N, Merdji H, Guelon D, Bohé J, Cayot S, Chabanne R, Constantin JM, Pereira B, Bouvier D, Andant N, Roth H, Thibault R, Sapin V, Hasselmann M, Souweine B, Cano N, Boirie Y, Dupuis C. Body composition and muscle strength at the end of ICU stay are associated with 1-year mortality, a prospective multicenter observational study. Clin Nutr 2023; 42:2070-2079. [PMID: 37708587 DOI: 10.1016/j.clnu.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/20/2023] [Accepted: 09/02/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND & AIMS After a prolonged intensive care unit (ICU) stay patients experience increased mortality and morbidity. The primary aim of this study was to assess the prognostic value of nutritional status, body mass composition and muscle strength, as assessed by body mass index (BMI), bioelectrical impedance analysis (BIA), handgrip (HG) test, and that of the biological features to predict one-year survival at the end of a prolonged ICU stay. METHODS This was a multicenter prospective observational study. Survivor patients older than 18 years with ICU length of stay >72 h were eligible for inclusion. BIA and HG were performed at the end of the ICU stay. Malnutrition was defined by BMI and fat-free mass index (FFMI). The primary endpoint was one-year mortality. Multivariable logistic regression was performed to determine parameters associated with mortality. RESULTS 572 patients were included with a median age of 63 years [53.5; 71.1], BMI of 26.6 kg/m2 [22.8; 31.3], SAPS II score of 43 [31; 58], and ICU length of stay of 9 days [6; 15]. Malnutrition was observed in 142 (24.9%) patients. During the 1-year follow-up after discharge, 96 (18.5%) patients died. After adjustment, a low HG test score (aOR = 1.44 [1.11; 1.89], p = 0.01) was associated with 1-year mortality. Patients with low HG score, malnutrition, and Albuminemia <30 g/L had a one-year death rate of 41.4%. Conversely, patients with none of these parameters had a 1-year death rate of 4.1%. CONCLUSION BIA to assess FFMI, HG and albuminemia at the end of ICU stay could be used to predict 1-year mortality. Their ability to identify patients eligible for a structured recovery program could be studied.
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Affiliation(s)
- Ali Ait Hssain
- Department of Intensive Care, Medical Intensive Care, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Nicolas Farigon
- Department of Clinical Nutrition, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Hamid Merdji
- Department of Intensive Care, Medical Intensive Care, Nouvel Hôpital Civil, Strasbourg University, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg University, Strasbourg, France
| | - Dominique Guelon
- Department of Perioperative Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Bohé
- Service D'Anesthésie-Réanimation-Médecine Intensive, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Sophie Cayot
- Department of Perioperative Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Russel Chabanne
- Department of Perioperative Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; Réanimation Chirurgicale Polyvalente, GH Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Bruno Pereira
- Biostatistics Unit, Department of Clinical Research and Innovation, Clermont Ferrand University, Clermont-Ferrand, France
| | - Damien Bouvier
- Department of Medical Biochemistry and Molecular Genetics, Clermont Ferrand University Hospital, Clermont-Ferrand, France
| | - Nicolas Andant
- Biostatistics Unit, Department of Clinical Research and Innovation, Clermont Ferrand University, Clermont-Ferrand, France
| | - Hubert Roth
- University Grenoble Alpes and Inserm U1055, Laboratory of Fundamental and Applied Bioenergetics (LBFA) and SFR Environmental and Systems Biology (BEeSy), 38059 Grenoble, France
| | - Ronan Thibault
- Service D'Endocrinologie-Diabétologie-Nutrition, Centre Labellisé de Nutrition Parentérale Au Domicile, CHU Rennes, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer Institute, NuMeCan, Rennes, France
| | - Vincent Sapin
- Department of Medical Biochemistry and Molecular Genetics, Clermont Ferrand University Hospital, Clermont-Ferrand, France
| | - Michel Hasselmann
- Department of Intensive Care, Medical Intensive Care, Nouvel Hôpital Civil, Strasbourg University, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg University, Strasbourg, France
| | - Bertrand Souweine
- Department of Intensive Care, Medical Intensive Care, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Clermont Auvergne University, CNRS, LMGE, F-63000 Clermont-Ferrand, France
| | - Noël Cano
- Department of Clinical Nutrition, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Clermont Auvergne University, Human Nutrition Unit, INRAE, CRNH Auvergne, Clermont-Ferrand, France
| | - Yves Boirie
- Department of Clinical Nutrition, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Clermont Auvergne University, Human Nutrition Unit, INRAE, CRNH Auvergne, Clermont-Ferrand, France
| | - Claire Dupuis
- Department of Intensive Care, Medical Intensive Care, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Clermont Auvergne University, Human Nutrition Unit, INRAE, CRNH Auvergne, Clermont-Ferrand, France.
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11
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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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Damico V, Murano L, Margosio V, Tognoni N, Dal Molin A, Bassi E, Busca E, Crimella F. Long-term effects of Coronavirus 2 infection after intensive care: a prospective study. Minerva Anestesiol 2023; 89:175-187. [PMID: 35833859 DOI: 10.23736/s0375-9393.22.16728-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND While the multi-organ manifestations of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection are now well-documented, the potential long-term implications of these manifestations remain to be uncovered. The aim of the study was to study the level and predictors of post-traumatic stress, anxiety and depression symptoms, quality of life and functional disability in COVID-19 survivors during the first year post Intensive Care Unit (ICU) discharge. METHODS A prospective longitudinal study, reported following the STROBE guidance, was conducted in adult patients with SARS-CoV-2 infection admitted to an Italian ICU from March 2020 to March 2021 who were followed until March 2022. RESULTS A total of 207 patients were included in the study, of which 145 (70.1%) were male. One hundred and six (51.2%) patients between six and 12 months after ICU discharge reported at least one physical or cognitive impairment. The concurrent prevalence of anxiety, depression and PTSD is present in 25/106 patients (23.6% of cases) at six months and increases in 29/106 patients (27.3% of cases) at 12 months. However, the prevalence of anxiety, depression and PTSD was observed in 86 patients (41.5%) at six months and it gets smaller in 78 patients (37.7%) at 12 months (P=0.049). The EqVAS score (58.8 vs. 72.3, P=0.017) and the Barthel Index (61.5 vs. 74.8, P<0.001) increased significantly between six and 12 months after ICU. CONCLUSIONS Our results show that functional and cognitive recovery improves between six and 12 months after ICU discharge with a high perception of the patients' quality of life. These results will help to inform health system planning and the development of multidisciplinary strategies to reduce chronic health loss among individuals with COVID-19.
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Affiliation(s)
- Vincenzo Damico
- Azienda Socio Sanitaria Territoriale of Lecco, Lecco, Italy -
| | | | - Viola Margosio
- Azienda Socio Sanitaria Territoriale of Lecco, Lecco, Italy
| | | | - Alberto Dal Molin
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Erika Bassi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Erica Busca
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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Ramnarain D, Pouwels S, Fernández-Gonzalo S, Navarra-Ventura G, Balanzá-Martínez V. Delirium-related psychiatric and neurocognitive impairment and the association with post-intensive care syndrome-A narrative review. Acta Psychiatr Scand 2023; 147:460-474. [PMID: 36744298 DOI: 10.1111/acps.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Delirium is common among patients admitted to the intensive care unit (ICU) and its impact on the neurocognitive and psychiatric state of survivors is of great interest. These new-onset or worsening conditions, together with physical alterations, are called post-intensive care syndrome (PICS). Our aim is to update on the latest screening and follow-up options for psychological and cognitive sequelae of PICS. METHOD This narrative review discusses the occurrence of delirium in ICU settings and the relatively new concept of PICS. Psychiatric and neurocognitive morbidities that may occur in survivors of critical illness following delirium are addressed. Future perspectives for practice and research are discussed. RESULTS There is no "gold standard" for diagnosing delirium in the ICU, but two extensively validated tools, the confusion assessment method for the ICU and the intensive care delirium screening checklist, are often used. PICS complaints are frequent in ICU survivors who have suffered delirium and have been recognized as an important public health and socio-economic problem worldwide. Depression, anxiety, post-traumatic stress disorder, and long-term cognitive impairment are recurrently exhibited. Screening tools for these deficits are discussed, as well as the suggestion of early assessment after discharge and at 3 and 12 months. CONCLUSIONS Delirium is a complex but common phenomenon in the ICU and a risk factor for PICS. Its diagnosis is challenging with potential long-term adverse outcomes, including psychiatric and cognitive difficulties. The implementation of screening and follow-up protocols for PICS sequelae is warranted to ensure early detection and appropriate management.
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Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburgh Medical Center, Hardenberg, The Netherlands.,Departmentof Medical and Clinical Psychology, Center of Research on Psychological and Somatic disease (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum, Krefeld, Germany
| | - Sol Fernández-Gonzalo
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Guillem Navarra-Ventura
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Vicent Balanzá-Martínez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
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14
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Lu J, Yu Y, Wang B, Zhang Y, Ji H, Chen X, Sun M, Daun Y, Pan Y, Chen Y, Yi Y, Dou X, Zhou L. The mediating role of self-efficacy between workplace violence and PTSD among nurses in Liaoning Province, China: A cross-sectional study. Front Psychol 2023; 14:1090451. [PMID: 36910753 PMCID: PMC9995771 DOI: 10.3389/fpsyg.2023.1090451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose Nurses are at high risk for workplace violence, which can lead to psychological problems. The purpose of this study was to determine the relationship between workplace violence, self-efficacy, and PTSD, and to further explore whether self-efficacy mediates the relationship between workplace violence and PTSD among Chinese nurses. Materials and methods This cross-sectional study was conducted in Liaoning Province, China in 2020. A total of 1,017 valid questionnaires were returned. Each questionnaire included the Workplace Violence Scale, the General Self-Efficacy Scale, the Post-traumatic Stress Disorder Scale (PTSS-10), and demographics information. A hierarchical multiple regression approach was used to explore the mediating role of self-efficacy in the relationship between workplace violence and PTSD. The mediation model was then tested by the PROCESS macro in SPSS. Results A total of 1,017 nurses were included in this study, and the average score of PTSD among Chinese nurses was 26.85 ± 13.13 (mean ± SD). After further adjustment for control variables, workplace violence was positively associated with PTSD, explaining 13% of the variance. High self-efficacy was associated with low PTSD, explaining 18% of the variance. Self-efficacy partially mediated the role of workplace violence and PTSD. Conclusion The high scores of PTSD among Chinese nurses demand widespread attention. Workplace violence is an important predictor of PTSD in nurses. Self-efficacy is a significant factor in improving PTSD in nurses and mediates the relationship between workplace violence and PTSD. Measures and strategies to improve self-efficacy may mitigate the effects of workplace violence on PTSD in nurses.
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Affiliation(s)
- Jiachen Lu
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yingying Yu
- School of Public Health, Dalian Medical University, Dalian, China
| | - Bin Wang
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanni Zhang
- Laboratory Animal Center, Affiliated Zhongshan Hospital Dalian University, Dalian, China
| | - Haoqiang Ji
- School of Public Health, Shandong University, Jinan, China
| | - Xu Chen
- School of Public Health, Dalian Medical University, Dalian, China
| | - Meng Sun
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yuxin Daun
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yuanping Pan
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yunting Chen
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yaohui Yi
- School of Public Health, Dalian Medical University, Dalian, China
| | - Xiaofeng Dou
- School of Public Health, Dalian Medical University, Dalian, China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, China
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15
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Cuzco C, Castro P, Marín Pérez R, Ruiz García S, Núñez Delgado AI, Romero García M, Martínez Momblan MA, Benito Aracil L, Carmona Delgado I, Canalias Reverter M, Nicolás JM, Martínez Estalella G, Delgado-Hito P. Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients' Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial. Crit Care Med 2022; 50:1757-1767. [PMID: 36178294 DOI: 10.1097/ccm.0000000000005676] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge. DESIGN A prospective, multicenter, randomized clinical trial. SETTING Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals. PATIENTS Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge. INTERVENTION The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward. MEASUREMENTS AND RESULTS Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG ( n = 91) and CG ( n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression ( p < 0.001) and the presence of depression ( p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes. CONCLUSIONS We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials. TRIAL REGISTRATION NCT04527627 ( https://clinicaltrials.gov/ct2/show/NCT04527627 ).
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Affiliation(s)
- Cecilia Cuzco
- Medical lntensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
| | - Pedro Castro
- Medical lntensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
| | - Raquel Marín Pérez
- Department of Cardiologic. Hospital Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Samuel Ruiz García
- Department of Cardiologic. Hospital Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana I Núñez Delgado
- Department of lntensive Care Unit, Hospital Valle d'Hebron, Barcelona, Spain
| | - Marta Romero García
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Antonia Martínez Momblan
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Llucia Benito Aracil
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - José M Nicolás
- Medical lntensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
| | - Gemma Martínez Estalella
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing Head, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Pilar Delgado-Hito
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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16
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Receipt of Recovery-Oriented Care Practices During Hospitalization for Sepsis. Crit Care Explor 2022; 4:e0766. [DOI: 10.1097/cce.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Collaborative integration of palliative care in critically Ill stroke patients in the neurocritical care unit: A single center pilot study. J Stroke Cerebrovasc Dis 2022; 31:106586. [PMID: 35667164 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients admitted to the Neurocritical Care Unit (NCCU) with moderate-to-severe acute strokes, along with their surrogate decision makers, have the potential for unrecognized or unmet emotional and psychological needs. Our primary objective was to determine if early integration of palliative care consultations within this cohort was feasible and would impact understanding, decision-making and emotional support to patients and their surrogate decision makers. Our secondary objective was to evaluate the long-term impact of early palliative care assessment on the development of post-traumatic stress disorder (PTSD). METHODS This was a single center prospective pilot study. Patients with moderate-to-severe ischemic and hemorrhagic strokes were randomized into two arms. The control arm received standard intensive care and the intervention arm received an additional early palliative care consultation within 72 hours of hospitalization. Study assessments with the participants were obtained on day 1-3, and day 5-7 of care with comparisons of total scores on the Questionnaire on Communication (QOC), Decisional Conflict Scale (DCS), and Hospital Anxiety and Depression Scale (HADS). Furthermore, comparisons of HADS and PTSD DSM-5 (PCL- 5) scores were completed at 3 months. Linear mixed effects models were conducted to examine the association between intervention and participant's scores. RESULTS A total of 22 participants were enrolled between February 2019 and April 2020. Statistically significant improvement in scores was seen in the total HADS score (p=0.043) and PCL5 score (p=0.033) at 3 months following intervention. CONCLUSION Collaboration between the intensive care and palliative care team with early palliative assessment may be beneficial in lowering anxiety, depression and PTSD symptoms in critically ill stroke patients and their caregivers. Further research is needed to validate these findings.
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Mergler BD, Goldshore MA, Shea JA, Lane-Fall MB, Hadler RA. The Patient Dignity Inventory and Dignity-Related Distress among the Critically Ill. J Pain Symptom Manage 2022; 63:359-365. [PMID: 34890727 DOI: 10.1016/j.jpainsymman.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022]
Abstract
CONTEXT Critical illness confers a significant risk of psychological distress, both during and after intensive care unit (ICU) admission. The Patient Dignity Inventory is a 25-item instrument initially designed to measure psychosocial, existential and symptom-related distress in terminally ill patients. OBJECTIVES This study was conducted to validate the inventory as a means of identifying distress in inpatient critical care settings. METHODS Single-center prospective cohort study of adult patients admitted to one of five ICUs within the University of Pennsylvania Health System for greater than 48 hours from January 2019 to February 2020. Patients completed the inventory in addition to the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-seven questionnaires. RESULTS The tool's internal structure was assessed via principal components analysis. 155 participants consented, completed the surveys and were included for analysis. Scores on the inventory showed evidence of internal consistency when used in critical care settings (Cronbach's α=0.95). Moreover, principal components analysis elucidated four themes prevalent in critically-ill patients: Illness-related Concerns, Interactions with Others, Peace of Mind and Dependency. Construct validity was assessed through correlational analysis with depression and anxiety questionnaires. Scores on the inventory appear to be valid for assessing dignity-related psychological concerns in the critical care setting although there is overlap among components and with anxiety and depression scores. CONCLUSIONS This study demonstrates that the inventory can be used to assess patient distress in critical care settings. Further research may elucidate the role of dignity-based interventions in treating and preventing post-intensive care psychological symptoms.
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Affiliation(s)
- Blake D Mergler
- Department of Anesthesiology and Critical Care (B.D.M., M.B.L.F.), University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Matthew A Goldshore
- Department of Surgery (M.A.G.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A Shea
- Department of Medicine (J.A.S.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghan B Lane-Fall
- Department of Anesthesiology and Critical Care (B.D.M., M.B.L.F.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel A Hadler
- Department of Anesthesia (R.A.H.), University of Iowa, Iowa City, Iowa, USA
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Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Rev Neurother 2021; 21:1159-1177. [PMID: 34519235 DOI: 10.1080/14737175.2021.1981289] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Post-intensive care syndrome (PICS) has only recently been recognized as a new clinical entity in patients surviving their intensive care unit (ICU) stay due to critical illness. With increasing survival rates of ICU patients worldwide, there is a rising interest regarding post-ICU recovery. AREAS COVERED First, based on the current literature a definition is provided of PICS, including the domains of impairments that comprise PICS along with the etiology and risk factors. Second, preventive measures and possible treatment strategies integrated in the follow-up care are described. Third, the authors will discuss the current SARS-Cov-2 pandemic and the increased risk of PICS in these post-ICU patients and their families. EXPERT OPINION PICS is a relatively new entity, which not only encompasses various physical, cognitive, and psychological impairments but also impacts global health due to long-lasting detrimental socioeconomic burdens. Importantly, PICS also relates to caregivers of post-ICU patients. Strategies to reduce this burden will not only be needed within the ICU setting but will also have to take place in an interdisciplinary, multifaceted approach in primary care settings. Additionally, the SARS-Cov-2 pandemic has a high burden on post-ICU patients and their relatives.
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Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburg Medisch Centrum Hardenberg, The Netherlands
| | - Emily Aupers
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands
| | - Annemarie Oldenbeuving
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Board, ADRZ (Admiraal De Ruyter Ziekenhuis), Goes, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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20
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Abstract
OBJECTIVES Parents value clear communication with PICU clinicians about possible patient and family outcomes (prognostic conversations). We describe PICU parent and attending physician reports and agreement regarding the occurrence of prognostic conversations. We queried parents and physicians about prognostic conversation content, which healthcare providers had prognostic conversations, and whether parents wanted more prognostic information. DESIGN Prospective cross-sectional survey study. SETTING University-based 40-bed PICU. PARTICIPANTS Parents and attending physicians of PICU patients with multiple organ dysfunction within 24 hours of PICU admission. INTERVENTIONS Surveys administered to parents and attending PICU physicians 5-10 days after PICU admission. MEASUREMENTS AND MAIN RESULTS Surveys asked parents and physicians to report the occurrence of prognostic conversations related to PICU length of stay, risk of PICU mortality, and anticipated post-PICU physical, neurologic, and psychologic morbidities for patients and post-PICU psychologic morbidities for parents. Of 101 participants, 87 parents and 83 physicians reported having prognostic conversations. Overall concordance between parents and physicians was fair (Kappa = 0.22). Parents and physicians most commonly reported prognostic conversations about PICU length of stay (67.3% and 63.3%, respectively) and patient post-PICU physical morbidity (n = 48; 48.5% and n = 45; 44.5% respectively). Conversations reported less often by parents and physicians were about patient post-PICU psychologic morbidity (n = 13; 12.9% and n = 20; 19.8%, respectively). Per parent report, bedside nurses and physicians provided most prognostic information. Chaplains (n = 14; 50%) and social workers (n = 17; 60%) were more involved in conversations regarding parent psychologic morbidities. Most commonly, parents requested more information about length of stay and their child's physical morbidities. Parents less frequently wanted information about their own psychologic morbidities. CONCLUSIONS Most parents and physicians report having prognostic conversations, primarily about length of stay and post-ICU physical morbidities. Concordance between parents and physicians is suboptimal. Future studies should evaluate prognostic conversations at other timepoints, how information is delivered, and how these conversations impact the PICU experience.
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21
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Cuzco C, Delgado-Hito P, Marín Pérez R, Núñez Delgado A, Romero-García M, Martínez-Momblan MA, Martínez Estalella G, Carmona Delgado I, Nicolas JM, Castro P. Patients' experience while transitioning from the intensive care unit to a ward. Nurs Crit Care 2021; 27:419-428. [PMID: 34402141 DOI: 10.1111/nicc.12697] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/05/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intensive care unit (ICU) patients can experience emotional distress and post-traumatic stress disorder when they leave the ICU, also referred to as post-intensive care syndrome. A deeper understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient-centred care and, ultimately, contribute to a positive experience. AIM To describe the patients' experience while transitioning from the ICU to a general ward. DESIGN A descriptive qualitative study. METHOD Data were gathered through in-depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. FINDINGS Forty-eight interviews were conducted. Impact on emotional well-being emerged as a main theme, comprising four categories with six subcategories. CONCLUSION Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well-being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward. RELEVANCE TO CLINICAL PRACTICE It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow-up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge.
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Affiliation(s)
- Cecilia Cuzco
- Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.,Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Delgado-Hito
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,International Research Project: Proyecto HU-CI, Madrid, Spain
| | - Raquel Marín Pérez
- Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cardiology, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Marta Romero-García
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,International Research Project: Proyecto HU-CI, Madrid, Spain
| | - María Antonia Martínez-Momblan
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Martínez Estalella
- Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.,Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José María Nicolas
- Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.,Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.,Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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22
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Effect of Nurse-Led Consultations on Post-Traumatic Stress and Sense of Coherence in Discharged ICU Patients With Clinically Relevant Post-Traumatic Stress Symptoms-A Randomized Controlled Trial. Crit Care Med 2021; 48:e1218-e1225. [PMID: 33048906 DOI: 10.1097/ccm.0000000000004628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the effect of nurse-led consultations on reducing post-traumatic stress symptoms and increasing sense of coherence in discharged ICU patients with clinically relevant post-traumatic stress symptoms and to identify variables associated with symptoms 12 months later. DESIGN A pragmatic nonblinded randomized controlled trial. SETTINGS Five surgical and medical ICUs at Oslo University Hospital. PATIENTS Adult patients treated in the ICU greater than or equal to 24 hours were screened with Post-Traumatic Stress Scale 10 intensive part B after ICU discharge. Those scoring greater than or equal to 25 were included in the study. INTERVENTION Patients randomized to intervention group were offered three nurse-led consultations within 2 months, and patients in the control group received standard care. MEASUREMENTS AND MAIN RESULTS Sense of Coherence Scale 13 and Post-Traumatic Stress Scale 10 intensive part B were completed after inclusion, and reevaluated after 3, 6, and 12 months. Linear mixed model for repeated measures and linear regression analyses were performed. Among 523 screened patients, 111 and 113 were randomized to intervention group and control group, respectively. Mean Post-Traumatic Stress Scale 10 intensive part B score was 37 (±10) before randomization. No differences in post-traumatic stress symptoms or sense of coherence were found between intervention group versus control group, with a mean Post-Traumatic Stress Scale 10 intensive part B score 39 (95% CI, 37-41) versus 37 (95% CI, 35-39), 32 (95% CI, 28-35) versus 32 (95% CI, 29-35), 31 (95% CI, 28-34) versus 30 (95% CI, 27-33), and 31 (95% CI, 28-34) versus 29 (95% CI, 26-33) at baseline, 3, 6, and 12 months, respectively. There was a significantly reduced Post-Traumatic Stress Scale 10 intensive part B score for both groups during the year (p = 0.001). Low sense of coherence, pain, and previous psychiatric problems were associated with increased level of post-traumatic stress symptoms at 12 months. CONCLUSIONS Nurse-led consultations did not reveal any significant effect on post-traumatic stress symptoms or sense of coherence after ICU discharge in patients with clinically relevant symptoms.
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23
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Early Detection of Patients at Risk of Developing a Post-Traumatic Stress Disorder After an ICU Stay. Crit Care Med 2021; 48:1572-1579. [PMID: 32885939 DOI: 10.1097/ccm.0000000000004551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of the Impact Event Scale-Revisited assessed following ICU discharge to predict the emergence of post-traumatic stress disorder symptoms at 3 months. DESIGN Prospective cohort study. SETTING Three medical or surgical ICU of a French university hospital (Lyon, France). PATIENTS Patients greater than or equal to 18 years old, leaving ICU after greater than or equal to 2 nights of stay, between September 2017 and April 2018. INTERVENTIONS Patients completed the Impact Event Scale-Revisited and the Peritraumatic Dissociative Experiences Questionnaire within 8 days after ICU discharge and the Impact Event Scale-Revisited again at 3 months by phone. Patients having an Impact Event Scale-Revisited greater than or equal to 35 at 3 months were considered as having post-traumatic stress disorder symptoms. MEASUREMENTS AND MAIN RESULTS Among the 208 patients screened, 174 were included and 145 reassessed by phone at 3 months. Among the patients included at baseline, 43% presented symptoms of acute stress. At 3 months, 13% had an Impact Event Scale-Revisited greater than or equal to 35 and 17% had a score between 12 and 34. Regarding the performance of the Impact Event Scale-Revisited performed within 8 days after the ICU discharge to predict post-traumatic stress disorder symptoms at 3 months, the area under the curve was 0.90 (95% CI, 0.80-0.99), and an Impact Event Scale-Revisited greater than or equal to 12 had a sensitivity of 90%, a specificity of 71%, a positive predictive value of 32%, and a negative predictive value of 98%. History of anxiety disorder odds ratio = 3.7 (95% CI, 1.24-11.05; p = 0.02) and Impact Event Scale-Revisited greater than or equal to 12 odds ratio = 16.57 (95% CI, 3.59-76.46; p < 0.001) were identified as risk factors for post-traumatic stress disorder symptoms. CONCLUSIONS Impact Event Scale-Revisited assessed at ICU discharge has a good ability for the detection of patients at risk of developing post-traumatic stress disorder symptoms. Patients with history of anxiety disorder and those presenting acute stress symptoms at ICU discharge are more at risk to develop post-traumatic stress disorder symptoms.
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Cuzco C, Castro Rebollo P, Marín Pérez R, Núñez Delgado AI, Romero García M, Martínez Momblan MA, Estrada Reventós D, Martínez Estalella G, Delgado-Hito P. Mixed-method research protocol: Development and evaluation of a nursing intervention in patients discharged from the intensive care unit. Nurs Open 2021; 8:3666-3676. [PMID: 33955196 PMCID: PMC8510756 DOI: 10.1002/nop2.894] [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: 12/01/2020] [Revised: 01/28/2021] [Accepted: 03/29/2021] [Indexed: 11/06/2022] Open
Abstract
AIM (a) To understand patients' lived experience at intensive care unit (ICU) discharge and (b) to evaluate the impact of a nursing empowerment intervention (NEI) on patients' anxiety and depression levels at ICU discharge. DESIGN A mixed-methods approach will be applied. METHODS In the qualitative phase, the hermeneutic phenomenological method will be used. Participants will be patients from three university hospitals who will be selected by purposive sampling. Data will be gathered through in-depth interviews and analysed using content analysis. The qualitative data obtained will be employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group will be used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale (HADS). Simple random probabilistic sampling will include 172 patients in this phase.
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Affiliation(s)
- Cecilia Cuzco
- Hospital Clinic, Barcelona, Spain.,Faculty of Medicine and Health Sciences, School of Nursing, Department of Fundamental and Medical-Surgical Nursing, Universitat de Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clinic Barcelona, Barcelona, Spain
| | - Pedro Castro Rebollo
- Hospital Clinic, Barcelona, Spain.,Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clinic Barcelona, Barcelona, Spain.,School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Marta Romero García
- Faculty of Medicine and Health Sciences, School of Nursing, Department of Fundamental and Medical-Surgical Nursing, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), l'Hospitalet de Llobregat, Spain
| | - M Antonia Martínez Momblan
- Faculty of Medicine and Health Sciences, School of Nursing, Department of Fundamental and Medical-Surgical Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Dolors Estrada Reventós
- Hospital Clinic, Barcelona, Spain.,Faculty of Medicine and Health Sciences, School of Nursing, Department of Fundamental and Medical-Surgical Nursing, Universitat de Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clinic Barcelona, Barcelona, Spain
| | - Gemma Martínez Estalella
- Hospital Clinic, Barcelona, Spain.,Faculty of Medicine and Health Sciences, School of Nursing, Department of Fundamental and Medical-Surgical Nursing, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), l'Hospitalet de Llobregat, Spain
| | - Pilar Delgado-Hito
- Faculty of Medicine and Health Sciences, School of Nursing, Department of Fundamental and Medical-Surgical Nursing, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), l'Hospitalet de Llobregat, Spain
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Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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26
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Flaws DF, Barnett A, Fraser J, Latu J, Ramanan M, Tabah A, Tippett V, Tronstad O, Patterson S. A protocol for tracking outcomes post intensive care. Nurs Crit Care 2021; 27:341-347. [PMID: 33609311 DOI: 10.1111/nicc.12613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Critically ill patients are more likely to survive intensive care than ever before due to advances in treatment. However, a proportion subsequently experiences post-intensive care syndrome (PICS) incurring substantial personal, social, and economic costs. PICS is a debilitating set of physical, psychological, and cognitive sequelae but the size and characteristics of the affected population have been difficult to describe, impeding progress in intensive care rehabilitation. AIMS AND OBJECTIVES The aim of this protocol is to describe recovery after admission to intensive care unit (ICU) and the predictors, correlates, and patient-reported outcomes for those experiencing PICS. The study will support the development of screening, diagnostic, and outcome measures to improve post-ICU recovery. DESIGN A prospective, multi-site observational study in three ICUs in Brisbane, Australia. Following consent, data will be collected from clinical records and using validated self-report instruments from 300 patients, followed up at 6 weeks and 6 months post ICU discharge. METHODS TOPIC is a prospective, multi-site observational study using self-report and clinical data on risk factors, including comorbidities, and outcomes. Data will be collected with consent from hospital records and participants 6 weeks and 6months post ICU discharge. RESULTS The main outcome measures will be self-reported physical, cognitive, and psychological function 6 weeks and 6 months post-ICU discharge. RELEVANCE TO CLINICAL PRACTICE This protocol provides a methodological framework to measure recovery and understand PICS. Data analysis will describe characteristics associated with recovery and PICS. The subsequent prediction and screening tools developed then aim to improve the effectiveness of post-ICU prevention and rehabilitation through more targeted screening and prediction and found a program of research developing a more tailored approach to PICS.
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Affiliation(s)
- Dylan F Flaws
- Department of Mental Health, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Intensive Care, Critical Care Research Group, Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adrian Barnett
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - John Fraser
- Department of Intensive Care, Critical Care Research Group, Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jiville Latu
- Department of Intensive Care, Intensive Care Unit, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Mahesh Ramanan
- Department of Intensive Care, Intensive Care Unit, Caboolture Hospital, Brisbane, Queensland, Australia.,Department of Intensive Care, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexis Tabah
- Department of Intensive Care, Intensive Care Unit, Redcliffe Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Vivienne Tippett
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Oystein Tronstad
- Department of Intensive Care, Critical Care Research Group, Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sue Patterson
- Department of Mental Health, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Intensive Care, Critical Care Research Group, Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
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27
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Hartman ME, Williams CN, Hall TA, Bosworth CC, Piantino JA. Post-Intensive-Care Syndrome for the Pediatric Neurologist. Pediatr Neurol 2020; 108:47-53. [PMID: 32299742 PMCID: PMC7306429 DOI: 10.1016/j.pediatrneurol.2020.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/17/2022]
Abstract
The number of children who survive critical illness has steadily increased. However, lower mortality rates have resulted in a proportional increase in post-intensive-care morbidity. Critical illness in childhood affects a child's development, cognition, and family functioning. The constellation of physical, emotional, cognitive, and psychosocial symptoms that begin in the intensive care unit and continue after discharge has recently been termed post-intensive-care syndrome. A conceptual model of the post-intensive-care syndrome experienced by children who survive critical illness, their siblings, and parents has been coined post-intensive-care syndrome in pediatrics. Owing to their prolonged hospitalizations, the use of sedative medications, and the nature of their illness, children with primary neurological injury are among those at the highest risk for post-intensive-care syndrome in pediatrics. The pediatric neurologist participates in the care of children with acute brain injury throughout their hospitalization and remains involved after the patient leaves the hospital. Hence it is important for pediatric neurologists to become versed in the early recognition and management of post-intensive-care syndrome in pediatrics. In this review, we discuss the current knowledge regarding post-intensive-care syndrome in pediatrics and its risk factors. We also discuss our experience establishing Pediatric Neurocritical Care Recovery Programs at two large academic centers. Last, we provide a battery of validated tests to identify and manage the different aspects of post-intensive-care syndrome in pediatrics, which have been successfully implemented at our institutions. Dissemination of this "road map" may assist others interested in establishing recovery programs, therefore mitigating the burden of post-intensive-care morbidity in children.
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Affiliation(s)
- Mary E. Hartman
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Critical care, Oregon Health & Science University
| | - Trevor A. Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Christopher C. Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Juan A. Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Neurology, Oregon Health & Science University
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Abstract
A maioria dos pacientes sobrevive ao episódio de doença crítica, contudo, muitos deles podem desenvolver alterações psicológicas após a alta desta unidade. Dada a natureza dos cuidados intensivos e as condições clínicas da maioria dos pacientes esta pesquisa tem como objetivo descrever os resultados da avaliação psicológica de pacientes três meses após a alta dos cuidados críticos. Foram avaliados 160 pacientes, no entanto, devido ao comprometimento neurológico apenas 137 conseguiram responder à avaliação psicológica. Os instrumentos utilizados foram: Planilha para coleta de dados do prontuário, instrumento de avaliação de memórias de UTI, Impact of Event Scale-Revised (IES-R) e Escala Hospitalar de Ansiedade e Depressão (HADS). Os resultados revelaram que a identificação precoce das complicações inerentes ao tratamento crítico poderá trazer benefícios para a prevenção de alterações emocionais/físicas crônicas subsequentes.
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30
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Koszalinski RS, Heidel RE, McCarthy J. Difficulty envisioning a positive future: Secondary analyses in patients in intensive care who are communication vulnerable. Nurs Health Sci 2019; 22:374-380. [PMID: 31736225 DOI: 10.1111/nhs.12664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to report a secondary analysis of data collected through a primary study. The primary study was a, randomized, control trial that used a team-designed (nursing, speech language hearing, engineering, communication sciences, and biostatistics), nurse-led, electronic communication intervention (Speak for Myself Voice) and measured patient outcomes of symptoms of anxiety and depression in five intensive care units at a regional, magnet-status, academic medical center. A secondary analysis of data using the Hospital Anxiety and Depression scale is reported here. The extant literature supports patient expressions of frustration, anger, anxiety, and depression when unable to communicate. This secondary analysis study report adds information about Hospital Anxiety and Depression subscales in the communication-vulnerable population. Implications include emerging awareness of potential feelings of depression and anxiety in patients who are receiving mechanical ventilation or who are unable to verbally communicate for any reason (e.g. obstruction, trauma, head and neck cancer) in the intensive care unit.
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Affiliation(s)
| | - R Eric Heidel
- Department of Surgery, The University of Tennessee School of Graduate Medicine, Knoxville, Tennessee, USA
| | - Jillian McCarthy
- Department of Audiology and Speech Pathology, The University of Tennessee Health Science Center, Knoxville, Tennessee, USA
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Kang J, Yun S, Cho YS, Jeong YJ. Post-intensive care unit depression among critical care survivors: A nationwide population-based study. Jpn J Nurs Sci 2019; 17:e12299. [PMID: 31621193 DOI: 10.1111/jjns.12299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/04/2019] [Indexed: 11/28/2022]
Abstract
AIM To investigate the incidence of post-intensive care unit (ICU) depression and its risk factors among critical care survivors. METHODS The study data were extracted from the database of the National Health Insurance Service of Korea. We retrospectively analyzed data from 161,977 adult patients who were admitted to the ICU for more than 24 hr from January 1, 2012 to December 31, 2014 and survived for more than 1 year after discharge. Risk factors for newly diagnosed depression (Code F32) were analyzed using multiple logistic regression analysis. RESULTS The incidence of post-ICU depression was 18.5%. The major risk factors were enteral nutrition (odds ratio [OR] = 2.28, 95% confidence interval [CI] = 2.19-2.36), cerebrovascular disease (OR = 1.59, 95% CI = 1.54-1.64), and hemi/paraplegia (OR = 1.48, 95% CI = 1.41-1.56). It was observed that cardiopulmonary resuscitation (OR = 0.55, 95% CI = 0.50-0.61) and myocardial infarction (OR = 0.75, 95% CI = 0.71-0.79) lowered depression. CONCLUSIONS The incidence of post-ICU depression was high and influenced by ICU treatment and physical impairments. Healthcare providers must pay attention to the psychological changes in survivors with major risk factors in the recovery process.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, Busan, Republic of Korea
| | - Seonyoung Yun
- Department of Nursing, Youngsan University, Yangsan, Kyungnam, Republic of Korea
| | - Young Shin Cho
- Surgical Intensive Care Unit, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Yeon Jin Jeong
- Department of Nursing, DongJu College, Busan, Republic of Korea
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Younes O, Amer R, Fawzy H, Shama G. Psychiatric disturbances in patients undergoing open-heart surgery. MIDDLE EAST CURRENT PSYCHIATRY 2019. [DOI: 10.1186/s43045-019-0004-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Emotional and behavioral problems have been noted in a considerable number of patients after open-heart surgery. However, great discrepancy exists in the literature regarding the frequency and the course of psychiatric symptoms, cognitive performance, and quality of life among those patients. This prospective study was designed to assess the pre- and postoperative psychiatric profile, as well as the quality of life of patients undergoing open-heart surgery.
Methods
One hundred patients who were prepared for cardiac surgery and met our selection criteria were recruited in this study. Each patient was subjected to the Hospital Anxiety and Depression Scale, the Mini-Mental State Examination with selective subtests of Wechsler Adult intelligence scale, and the Short Form 36 questionnaire to assess psychiatric symptoms, cognitive performance, and quality of life respectively. Assessment was done for each of the evaluated items before surgery as well as at 1 week and 6 months postoperatively.
Results
The anxiety and depressive symptoms were significantly lower at 6 months postoperatively than preoperatively. The cognitive performance declined after 1 week, then improved significantly at the 6-month follow-up. The quality of life scale was significantly lower preoperatively than after surgery.
Conclusions
Anxiety and depressive symptoms, which occurred in substantial percentage of patients undergoing open-heart surgery, were gradually improved with time. Cognitive functions showed early deterioration with significant improvement at 6 months. Psychiatric problems had an adverse impact on patients’ quality of life which raised the importance of psychiatric consultation before and after cardiac surgeries to shorten recovery time.
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Valsø Å, Rustøen T, Skogstad L, Schou-Bredal I, Ekeberg Ø, Småstuen MC, Myhren H, Sunde K, Tøien K. Post-traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge. Nurs Crit Care 2019; 25:117-125. [PMID: 31418993 DOI: 10.1111/nicc.12466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Post-traumatic stress (PTS) symptoms following intensive care unit (ICU) treatment can lead to post-traumatic stress disorder and represent a severe health burden. In trauma patients, a strong sense of coherence (SOC) is associated with fewer PTS symptoms. However, this association has not been investigated in a general ICU sample. AIMS AND OBJECTIVES To examine the occurrence of PTS symptoms in general ICU patients early after ICU discharge and to assess possible associations between PTS symptoms and SOC, ICU memory, pain, and demographic and clinical characteristics. DESIGN This was a cross-sectional study. METHODS Adult patients aged ≥18 years admitted for ≥24 hours to five ICUs between 2014 and 2016 were recruited. PTS symptoms and SOC were measured at the ward within the first week after discharge from the ICU using the Posttraumatic Stress Scale-10 and Sense of Coherence Scale-13. Multiple linear regression analysis was used to identify associations between PTS symptoms and SOC and the selected independent variables. RESULTS A total of 523 patients were included (17.8% trauma patients; median age 57 years [range 18-94]; 53.3% male). The prevalence of clinically significant PTS symptoms was 32%. After adjustments for gender and age, lower SOC (P < 0.001), more ICU delusional memories (P < 0.001), greater pain interference (P < 0.001), not being a trauma patient (P = 0.02), and younger age (P = 0.03) were significantly associated with more PTS symptoms. CONCLUSIONS One third of patients experienced clinically relevant PTS symptoms early after discharge from the ICU. In the present study, SOC, delusional memory, pain interference, younger age, and not being a trauma patient were factors associated with more PTS symptoms. RELEVANCE TO CLINICAL PRACTICE Early individual follow up after ICU discharge focusing on pain relief and delusional memory may reduce PTS symptoms, with a potential of improving rehabilitation.
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Affiliation(s)
- Åse Valsø
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Laila Skogstad
- Department of Nursing and Health Promotion, Prehospital Trauma Care - Bachelor paramedics, OsloMet - Oslo Metropolitan University of Oslo, Oslo, Norway
| | - Ingerl Schou-Bredal
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Unit for Breast- and Endocrine Surgery, Division of Cancer, Oslo University Hospital, Oslo, Norway
| | - Øivind Ekeberg
- Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Milada C Småstuen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Public Health, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Hilde Myhren
- Department of Acute medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Kjetil Sunde
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kirsti Tøien
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Karnatovskaia LV, Schulte PJ, Philbrick KL, Johnson MM, Anderson BK, Gajic O, Clark MM. Psychocognitive sequelae of critical illness and correlation with 3 months follow up. J Crit Care 2019; 52:166-171. [PMID: 31078997 DOI: 10.1016/j.jcrc.2019.04.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/22/2019] [Accepted: 04/27/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Over a third of critical illness survivors manifest significant psychocognitive impairments following discharge from the intensive care unit (ICU). It is not known which patient populations are at highest risk or if assessment at ICU discharge can guide outpatient treatment prioritization. MATERIALS AND METHODS Prospective single center study in an academic medical center encompassing six types of ICUs assessed prevalence of psychocognitive morbidity based on ICU type and associations between initial and 3 month follow-up evaluation. Adult patients with >48 h ICU stays completed the Hospital Anxiety and Depression Scale (HADS), Impact of Events Scale-Revised (IES-R), and Montreal Cognitive Assessment-Blind (MoCA-blind). RESULTS Of 299 patients who underwent initial assessment, 174 (58%) completed follow-up. Length of stay, MoCA-Blind, HADS-A/D and IES-R scores were similar across ICUs. Most commonly observed impairment in-hospital was cognitive (58%) followed by anxiety (45%), acute stress (39%) and depression (37%). There were significant correlations between in-hospital and follow-up psychocognitive outcomes. CONCLUSIONS There was no significant difference in impairment by ICU type. Significant correlation between the initial assessment and follow-up scores suggests that early screening of high risk patients may identify those at greatest risk of sustained morbidity and facilitate timely intervention.
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Affiliation(s)
- Lioudmila V Karnatovskaia
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Phillip J Schulte
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America
| | - Kemuel L Philbrick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Margaret M Johnson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Brenda K Anderson
- Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, MN, United States of America
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
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Kerckhoffs MC, Kosasi FFL, Soliman IW, van Delden JJM, Cremer OL, de Lange DW, Slooter AJC, Kesecioglu J, van Dijk D. Determinants of self-reported unacceptable outcome of intensive care treatment 1 year after discharge. Intensive Care Med 2019; 45:806-814. [PMID: 30840124 PMCID: PMC6534510 DOI: 10.1007/s00134-019-05583-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Survivors of critical illness often suffer from reduced health-related quality of life (HRQoL) due to long-term physical, cognitive, and mental health problems, also known as post-intensive care syndrome (PICS). Some intensive care unit (ICU) survivors even consider their state of health unacceptable. The aim of this study was to investigate the determinants of self-reported unacceptable outcome of ICU treatment. METHODS Patients who were admitted to the ICU for at least 48 h and survived the first year after discharge completed validated questionnaires on overall HRQoL and the components of PICS and stated whether they considered their current state of health an acceptable outcome of ICU treatment. The effects of overall HRQoL and components of PICS on unacceptable outcome were studied using multiple logistic regression analysis. RESULTS Of 1453 patients, 67 (5%) reported their health state an unacceptable outcome of ICU treatment. These patients had a lower score on overall HRQoL (EQ-5D-index value of 0.57 vs. 0.81; p < 0.001), but we could not determine a cutoff value of the EQ-5D-index value that reliably identified unacceptable outcome. In the multivariate analysis, only the hospital anxiety and depression scale was significantly associated with an unacceptable outcome (OR 2.06, 99% CI 1.18-3.61). CONCLUSIONS Although there is a strong association between low overall HRQoL and self-reported unacceptable outcome of ICU treatment, patients with low overall HRQoL may still consider their outcome acceptable. The mental component of PICS, but not the physical and cognitive component, is strongly associated with self-reported unacceptable outcome.
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Affiliation(s)
- Monika C Kerckhoffs
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Mail Stop F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Felicia F L Kosasi
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Mail Stop F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Ivo W Soliman
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Mail Stop F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Mail Stop F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Mail Stop F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Mail Stop F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Mail Stop F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Diederik van Dijk
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Mail Stop F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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36
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Abstract
Critical illness survivors frequently have substantial psychiatric morbidity, including posttraumatic stress, depression, and anxiety symptoms. Prior psychiatric illness is a potent predictor of postcritical illness psychiatric morbidity. Early emotional distress and memories of frightening psychotic and nightmarish intensive care unit (ICU) experiences are risk factors for longer term psychiatric morbidity. ICU diaries may be effective in decreasing psychiatric morbidity after critical illness, though these and other interventions deserve further study.
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Affiliation(s)
- Elizabeth Prince
- Department of Psychiatry, University of Maryland Medical Center, 22 South Greene Street Room P1H10, Baltimore, MD 21201, USA
| | - Ted Avi Gerstenblith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 106 and 115, Baltimore, MD 21287, USA
| | - Dimitry Davydow
- CHI Franciscan Health System St. Joseph Medical Center, 1717 South J Street MS 01-01, Tacoma, WA 98405, USA
| | - Oscar Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 106 and 115, Baltimore, MD 21287, USA.
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van Mol M, Ista E, van Dijk M. Implementation and evaluation of a follow-up programme after intensive care treatment: A practice development project. Intensive Crit Care Nurs 2018; 49:6-13. [PMID: 29730086 DOI: 10.1016/j.iccn.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/04/2018] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to measure the effects of a newly developed follow-up programme on intensive care unit patient quality of care, as perceived by their relatives, and the appropriateness of the programme according to nurses. METHODS AND SETTING This before and after implementation study was conducted in a level III intensive care unit for adult patients and related follow-up wards and included 135 intensive care nurses and 105 general ward nurses. The implemented programme included a personalised poster, a revised discharge protocol and follow-up visits on the ward. Eligible relatives of patients who had remained in the intensive care for a minimum of 48 hours were included. MAIN OUTCOME MEASURES AND RESULTS Total quality of care and communication were assessed by relatives as high according to the Quality Monitor. Most intensive care nurses evaluated the usefulness of the discharge protocol as positive (71.8% partly/totally agreed) and in accordance with the patients' needs (82.1% partly/totally agreed). CONCLUSION Communication and general support as perceived by patients' relatives improved; however, no influence on the total quality of care of the revised discharge protocol was shown. Nurses considered the programme as useful. The intervention might enable nurses to better respond to the instrumental and affective needs of patients and their relatives.
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Affiliation(s)
- Margo van Mol
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Erwin Ista
- Department of Intensive Care Children, Erasmus MC University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Monique van Dijk
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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