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Rourke S, Paterson C. How Does Health-Related Quality of Life Change Over Time in Cancer Survivors Following an Admission to the Intensive Care Unit?: An Integrative Review. Cancer Nurs 2024; 47:100-111. [PMID: 36066345 DOI: 10.1097/ncc.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer survivors account for 15% to 20% of all intensive care unit (ICU) admissions. In general ICU populations, patients are known to experience reduced health-related quality of life (HRQoL). However, little is known about HRQoL impacts among cancer survivors following a critical illness in ICU. OBJECTIVE The aim of this study was to critically synthesize the evidence to further understand the impact of a critical illness and ICU admission in cancer survivors. METHODS An integrative review was conducted and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Three electronic databases were searched (MEDLINE, CINAHL, and EMBASE) using keywords and Boolean logic. Quality appraisal, data extraction, and a narrative synthesis were completed for all included studies by 2 reviewers. RESULTS Eleven publications met inclusion criteria. Health-related quality-of-life domains most frequently reported in cancer survivors after discharge from ICU included the following: physical function limitations, physical symptoms, and anxiety/depression. CONCLUSIONS Health-related quality of life decreased immediately after the admission to ICU with a gradual increase in the 3 to 12 months following. Cancer survivors are vulnerable to physical limitations, pain, and social isolation after an admission to ICU. IMPLICATIONS FOR PRACTICE Cancer survivors who have been affected by a critical illness are at risk of reduced HRQoL after an admission to ICU. This integrative review will help clinicians and researchers to develop patient-centered models of care during the recovery of critical illness, which are currently lacking in service delivery.
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Affiliation(s)
- Shalyn Rourke
- Author Affiliations: Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group (Ms Rourke, Dr Paterson) and School of Nursing, Midwifery and Public Health (Ms Rourke, Dr Paterson), University of Canberra, Bruce; and Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, ACT Health Directorate Level 3, Canberra Hospital, Garran (Ms Rourke, Dr Paterson), Canberra, Australian Capital Territory, Australia; and Robert Gordon University, Aberdeen, Scotland, United Kingdom (Ms Rourke, Dr Paterson)
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Hoffmann M, Nydahl P, Brauchle M, Schwarz C, Amrein K, Jeitziner MM. [Ways of supporting relatives in intensive care units : Overview and update]. Med Klin Intensivmed Notfmed 2022; 117:349-357. [PMID: 35394164 PMCID: PMC8992398 DOI: 10.1007/s00063-022-00915-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/02/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Relatives of patients in the intensive care unit (ICU) face a challenging situation: they often experience an existential crisis with great emotional stress and at the same time they are often actively involved in therapeutic decisions. The visiting restrictions of the coronavirus disease 2019 (COVID-19) pandemic have created new challenges in providing support to relatives. OBJECTIVES The aim of this work is to present current and new developments in supporting relatives of critically ill patients in the form of a narrative review. RESULTS In recent years, numerous new approaches and projects to support relatives have been developed. They can be assigned to the following six areas: 1) presence of relatives in the ICU, 2) proactive involvement in care, 3) structured communication/information and online offers, 4) multidisciplinary cooperation, 5) organizational management and 6) follow-up offers. The evidence and the current implementation status of these measures are very heterogeneous internationally and nationally. CONCLUSIONS Measures for providing support for ICU relatives are diverse. Some can even be implemented despite visit bans. Recent digital developments enable virtual visits and a better exchange of information between the ICU team and relatives.
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Affiliation(s)
- Magdalena Hoffmann
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
- Research Unit for Safety and Sustainability in Health Care c/o Klinische Abteilung für plastische, ästhetische und rekonstruktive Chirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich.
- Stabsstelle für Qualitäts- und Risikomanagement, LKH-Universitätsklinikum Graz, Graz, Österreich.
| | - Peter Nydahl
- Pflegewissenschaft und -entwicklung, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Maria Brauchle
- Abteilung für Anästhesie und Intensivmedizin, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Christine Schwarz
- Research Unit for Safety and Sustainability in Health Care c/o Klinische Abteilung für plastische, ästhetische und rekonstruktive Chirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich
- Stabsstelle für Qualitäts- und Risikomanagement, LKH-Universitätsklinikum Graz, Graz, Österreich
| | - Karin Amrein
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Marie-Madlen Jeitziner
- Universitätsklinik für Intensivmedizin, Universitätsspital Bern (Inselspital), Universität Bern, Bern, Schweiz
- Pflegewissenschaft - Nursing Science (INS), Universität Basel, Medizinische Fakultät, Basel, Schweiz
- Departement Public Health (DPH), Basel, Schweiz
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Wendlandt B, Chen YT, Lin FC, Toles M, Gaynes B, Hanson L, Carson S. Posttraumatic Stress Disorder Symptom Trajectories in ICU Family Caregivers. Crit Care Explor 2021; 3:e0409. [PMID: 33912839 PMCID: PMC8078333 DOI: 10.1097/cce.0000000000000409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
To use latent class growth analysis to identify posttraumatic stress disorder symptom trajectories in ICU family caregivers. DESIGN Prospective cohort study. SETTING The medical ICU at a tertiary-care center in the United States. PARTICIPANTS Adult patients experiencing acute cardiorespiratory failure (defined as requiring at least one of the following: 1) vasopressors, 2) noninvasive positive pressure ventilation, 3) high-flow nasal cannula, or 4) mechanical ventilation) were enrolled in a pair with their primary family caregivers. MEASUREMENTS AND MAIN RESULTS Participants were enrolled within the first 48 hours of ICU admission. Family caregiver posttraumatic stress disorder symptoms were measured using the Impact of Events Scale-Revised at four time points: at enrollment, shortly after ICU discharge, and at 3 and 6 months after ICU discharge. The data were examined using latent class growth analysis to identify posttraumatic stress disorder symptom trajectories. Two distinct symptom trajectories were identified: a persistently high trajectory, characterized by high posttraumatic stress disorder symptoms at initial assessment, which remained elevated over time, and a persistently low trajectory, characterized by low posttraumatic stress disorder symptoms at initial assessment, which remained low over time. Approximately two-thirds of caregivers belonged to the persistently high trajectory, and one-third of caregivers belonged to the persistently low trajectory. CONCLUSIONS Using latent class growth analysis to measure 6-month ICU family caregiver posttraumatic stress disorder symptom trajectories, we identified two distinct trajectories (persistently low and persistently high). A larger cohort study is warranted to further delineate posttraumatic stress disorder trajectories in this population, with the ultimate goal of targeting high-risk caregivers for interventions to reduce psychologic distress and improve long-term caregiver outcomes.
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Affiliation(s)
- Blair Wendlandt
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Yi Tang Chen
- College of Public Health, The Ohio State University, Columbus, OH
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Mark Toles
- University of North Carolina School of Nursing, Chapel Hill, NC
| | - Bradley Gaynes
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Laura Hanson
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Shannon Carson
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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Mistraletti G, Mezzetti A, Anania S, Ionescu Maddalena A, Del Negro S, Giusti GD, Gili A, Iacobone E, Pulitanò SM, Conti G, Bocci MG. Improving communication toward ICU families to facilitate understanding and reduce stress. Protocol for a multicenter randomized and controlled Italian study. Contemp Clin Trials 2019; 86:105847. [PMID: 31525488 DOI: 10.1016/j.cct.2019.105847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/25/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Families of ICU patients have a pressing need for information: they find themselves suddenly in a complex technical environment often because of a life-threatening illness of a loved one. Some evidence suggests that specific communication tools (like websites or brochures) could improve the experience of ICU families. DESIGN Randomized, multicenter, stepped wedge trial for large-scale assessment of the effectiveness of a multitasking intervention to improve communication with families of critically ill patients. MAIN OUTCOME correct understanding of the prognosis. SECONDARY OUTCOMES correct understanding of medical treatments, prevalence of anxiety, depression and post-traumatic stress symptoms in the first ICU week. Prevalence of PTSD 6 months from ICU discharge. Empathy and burnout among ICU staff. Prevalence of refusals for tissues/organ donation, and medical claims. SUBJECTS 2100 ICU relatives of critically ill patients. INTERVENTIONS The intervention employs specific tools especially designed to raise the correctness of information and to improve the quality of communication: a website presenting the ICU world and justifying the relatives' emotions, with a webpage specifically dedicated to each participating ICU; a standard brochure; eight posters for the families' waiting room and a signboard for the ICU door. MEASUREMENTS AND MAIN RESULTS The study plans to assess these materials in up to 300 Italian ICUs that will participate, according to a five waves program, each one with randomized starting order. This way the effect of the intervention will be evaluated simultaneously. CONCLUSION This is an educational study, aiming to spread good medical practices, while also verifying their real effectiveness in a large number of ICUs. TRIAL REGISTRATION NUMBER NCT03438175.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy; SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy.
| | - Andrea Mezzetti
- AUSL Toscana Centro, SOS 118 Emergenza Territoriale, Empoli, Italy
| | - Stefania Anania
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | - Alessandra Ionescu Maddalena
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Silvia Del Negro
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | | | - Alessio Gili
- Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Italy
| | - Emanuele Iacobone
- SAR, Dipartimento Emergenza-Urgenza, AV3 Ospedale di Macerata, ASUR Marche, Italy
| | - Silvia Maria Pulitanò
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giorgio Conti
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Grazia Bocci
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Hoffmann M, Holl AK, Burgsteiner H, Eller P, Pieber TR, Amrein K. Prioritizing information topics for relatives of critically ill patients : Cross-sectional survey among intensive care unit relatives and professionals. Wien Klin Wochenschr 2018; 130:645-652. [PMID: 30094664 PMCID: PMC6244832 DOI: 10.1007/s00508-018-1377-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/23/2018] [Indexed: 11/29/2022]
Abstract
A patient’s admission to an intensive care unit (ICU) has a significant impact on family members and other relatives. In order for them to be able to cope with such a stressful situation, the availability of appropriate understandable and accessible information is crucial. The information asymmetry between relatives and medical professionals may adversely affect satisfaction of relatives and their risk of subsequent anxiety, depression and stress symptoms. The aim of this study was therefore to understand which topics are most important to the relatives of ICU patients and to quantify the perceptions of medical professionals regarding the information needs of relatives. A cross-sectional survey was conducted in 2015. The survey had 42 questions, such as ‘diagnosis’, ‘treatment’, ‘comfort’, ‘family’ and ‘end of life’. In total, the survey was handed out to four different groups. A total of 336 persons answered the survey (26 relatives, 28 ICU physicians, 202 ICU nurses and 80 ICU medical professionals in a closed Facebook© group [Facebook, Menlo Park, California, USA]). Relatives ranked the five most important topics as follows: ‘recent events (crisis)’, ‘my participation’, ‘contamination in hospital’, ‘physical pain’, and ‘probability’. Several significant differences (p<0.001) were detected, for example for the topics fever, medication, recent events (crisis), appointments, relapse, and investigations. Even the topic with the lowest ranking (religion) had a score of 3.15 (min. 1.00, max. 5.00) among relatives. The ICU professionals appear to have divergent opinions regarding the most important topics for ICU relatives as compared to relatives themselves.
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Affiliation(s)
- Magdalena Hoffmann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. .,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria. .,Research Unit for Safety in Health, Medical University of Graz, Graz, Austria.
| | - Anna K Holl
- Department for Psychiatry, University Hospital Graz, Graz, Austria
| | - Harald Burgsteiner
- Institute for Digital Competence and Media Education, University College of Teacher Education Styria, Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Joanneum Research, Graz, Austria
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Hoffmann M, Taibinger M, Holl AK, Burgsteiner H, Pieber TR, Eller P, Sendlhofer G, Amrein K. [Online information for relatives of critically ill patients : Pilot test of the usability of an ICU families website]. Med Klin Intensivmed Notfmed 2018; 114:166-172. [PMID: 30083872 DOI: 10.1007/s00063-018-0467-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/20/2018] [Accepted: 07/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Relatives of intensive care patients have a very high need for information. This is due to the acute and serious, often life-threatening illness of the patients and the very complex and technical environment of an intensive care unit (ICU). Unmet needs for information can increase anxiety, sleep disorders, stress, and depressive symptoms in the relatives. OBJECTIVES The potential of the ICU families website in terms of usability and functionality during real-time testing were evaluated. METHODS The ICU families project created a dynamic online information platform in the form of a password-protected website. It contains pictures, written explanations, 5 movies, a forum and a diary function. The usability of the website was tested among 10 lay people and 10 experts (7 nurses and 3 physicians) according to the Think Aloud Method. RESULTS The outcome is qualitative feedback based on video documentation by laypeople and suggestions by experts. Criticisms mentioned by the test subjects were insufficient image material, small size of the operator contact link and lack of a home button. With a mean of 9.1 (rating scale, 0 = very poor, 10 = very good), the website was almost universally recommended by the experts. CONCLUSIONS This usability test of a website for relatives of ICU patients conducted among 20 test subjects showed the biggest challenges related to solving individual test scenarios and provided valuable hints for improving website usability. Features of the website highlighted as positive were the clear layout, the symbols, the diary and the consideration of children. This information was used to improve the site for subsequent roll-out in a randomized, controlled and multicentre study.
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Affiliation(s)
- M Hoffmann
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich. .,Research Unit for Safety in Health, Klinische Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Graz, Graz, Österreich. .,Stabsstelle Qualitäts- und Risikomanagement, LKH-Univ. Klinikum, Graz, Österreich.
| | | | - A K Holl
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, LKH-Univ. Klinikum, Graz, Österreich
| | - H Burgsteiner
- Institut für Digitale Kompetenz und Medienpädagogik, Pädagogische Hochschule Steiermark, Graz, Österreich
| | - T R Pieber
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich.,Joanneum Research, Health, Graz, Österreich
| | - P Eller
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - G Sendlhofer
- Research Unit for Safety in Health, Klinische Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Graz, Graz, Österreich.,Stabsstelle Qualitäts- und Risikomanagement, LKH-Univ. Klinikum, Graz, Österreich
| | - K Amrein
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
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Alfheim HB, Hofsø K, Småstuen MC, Tøien K, Rosseland LA, Rustøen T. Post-traumatic stress symptoms in family caregivers of intensive care unit patients: A longitudinal study. Intensive Crit Care Nurs 2018; 50:5-10. [PMID: 29937075 DOI: 10.1016/j.iccn.2018.05.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To describe the prevalence and trajectory of family caregivers' post-traumatic stress symptoms during the first year after a patient's admission to the intensive care unit and identify associations between family caregivers' background characteristics, hope and post-traumatic stress symptoms. RESEARCH METHODOLOGY/DESIGNS Family caregivers of intensive care unit patients (n = 211) completed questionnaires at patient admission to the intensive care unit and thereafter at 1, 3, 6, and 12 months. Mixed-model analyses were performed. SETTING Four intensive care units in a university hospital in Norway. MAIN OUTCOME MEASURES Impact of Event Scale-Revised and Herth Hope Index. RESULTS On admission, 54% of family caregivers reported high post-traumatic stress symptom levels, which decreased during the first six months after patient discharge. Lower levels of hope, being younger, having more comorbidities and being on sick leave were associated with higher post-traumatic stress symptom levels. Being the parent of the patient was associated with decreased post-traumatic stress symptom levels. CONCLUSIONS Family caregivers of intensive care unit patients report high levels of post-traumatic stress symptoms. Higher levels of hope were associated with fewer post-traumatic stress symptoms.
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Affiliation(s)
- Hanne Birgit Alfheim
- Postoperative and Intensive Care and Department, 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; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, NO-0316 Oslo, Norway.
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggt. 15b, 0456 Oslo, Norway.
| | - Milada Cvancarova Småstuen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Department of Public Health, Faculty of Nursing Science, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs plass, N-0130 Oslo, Norway.
| | - Kirsti Tøien
- Postoperative and Intensive Care and Department, 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.
| | - Leiv Arne Rosseland
- 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 Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, NO-0316 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; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, NO-0316 Oslo, Norway.
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Association between resilience, acute stress symptoms and characteristics of family members of patients at early admission to the intensive care unit. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.mhp.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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