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

Communication intervention for families in adult intensive care units during COVID-19 pandemic: A systematic review

BACKGROUND

Restrictions on ICU family visitation during COVID-19 pandemic posed communication challenges for families, patients, and healthcare teams. Diverse approaches were used to overcome communication barriers. As ICUs begin to reinstate family visitation, it is timely to review the lessons learned from these interventions during the pandemic.

OBJECTIVES

To identify and evaluate content and qualities of the studies that describe communication interventions for families of adult ICU patients during the COVID-19 pandemic.

METHODS

Following the PRISMA guidelines, we searched PubMed, Embase, CINAHL, and Web of Science for studies that (1) involved communication intervention for families in adult ICU settings, (2) were published between January 2020 and September 2022, and (3) were published in English. We excluded studies that were not from peer-reviewed journal articles or in English.

RESULTS

Of 2,628 articles initially identified, we reviewed the 23 selected studies (20 non-experimental and 3 experimental studies). Most of the studies were published in 2022 (n = 14, 60.9 %) and conducted in Europe (n = 13, 56.5 %). Various communication methods (e.g., video calls, telephone, applications) were used to provide information, emotional support, and virtual access to patients and their families. Video calls were the most frequently used intervention. Many interventions included healthcare teams providing updates on the patient's condition or treatment to the family.

CONCLUSIONS

The COVID-19 pandemic prompted the adoption of diverse communication approaches for families in ICU settings, despite many limitations, including technical challenges. Insights gained from this experience will help expedite flexibility and diversity in designing communication interventions for ICU family members.

Mixed-method acceptability evaluation of a co-designed bundled intervention to support communication for patients with an advanced airway in the intensive care unit during a pandemic

BACKGROUND

Although bundled communication interventions are recommended to address communication barriers for patients with an advanced airway in the intensive care unit (ICU) such interventions have not been evaluated in pandemic conditions.

AIM

To evaluate the acceptability, appropriateness, and feasibility of a co-designed bundled intervention to support communication with adult patients with an advanced airway in ICU in pandemic conditions.

STUDY DESIGN

Prospective, convergent mixed method design in a single centre medical-surgical ICU in Toronto, Canada between September 2021-March 2022. After the use of the co-designed bundled communication intervention quantitative data were collected from health care providers using validated acceptability, appropriateness, and feasibility measures and analysed using descriptive statistics. Qualitative data were collected from providers, patients and families using semi-structured interviews and analysed using content analysis applying the theoretical framework of acceptability. Joint table analysis enabled the integration of the two data sets.

RESULTS

A total of 64 (41.3%) HCPs responded to the survey: 54 (84.4%) rated the intervention acceptable; 55 (85.9%) appropriate; and 49 (76.6%) feasible for use in this context. Qualitative data (23 interviews: 13 healthcare providers, 6 families and 4 patients) and the joint table analysis extended the understanding that intervention acceptability was related to positive affective attitudes and reduced communication frustration. Appropriateness and feasibility were promoted through intervention alignment with values, ability to personalize tools, and ease of access. Recommendations to improve the acceptability included adaptation for immobilized and/or restrained patients, additional education, and integration into existing workflows.

CONCLUSIONS

This mixed method evaluation of a co-designed bundled intervention to support patient communication in the ICU during pandemic conditions demonstrated high rated and described acceptability, appropriateness, and feasibility by participants.

RELEVANCE TO CLINICAL PRACTICE

A co-designed communication intervention demonstrating stakeholder acceptability, appropriateness, and feasibility can be implemented into clinical practice in pandemic and other infection prevention and control contexts.

Experiences of isolation in patients in the intensive care unit during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, patients in the intensive care unit have been subjected to strict isolation precautions, and potentially long and complicated patient courses. The aim of the study is to provide an investigation of the experiences of isolation in COVID-19-positive patients in the ICU during the first phase of the COVID-19 pandemic in Denmark.

METHODS

The study was performed in a 20-bed ICU at a university hospital in Copenhagen, Denmark. The study is based on a phenomenological framework, Phenomenologically Grounded Qualitative Research. This approach provides insights into the tacit, pre-reflective and embodied dimensions of the specific experience under investigation. Methods included a combination of in-depth structured interviews with ICU patients 6-12 months after ICU discharge, and observations from inside the isolated patient rooms. The descriptions of experiences gathered through the interviews were subjected to systematic thematic analysis.

RESULTS

Twenty-nine patients were admitted to the ICU in the period 10 March and 19 May 2020. A total of six patients was included in the study. Themes consistently reported across all patients included (1) being objectified to degrees that implied self-alienation; (2) feeling a sense of being in captivity; (3) being in an experiential state of surrealism, and finally (4) experiencing extreme loneliness and intercorporeal deprivation.

CONCLUSION

This study provided further insights into the liminal patient experiences of being isolated in the ICU due to COVID-19. Robust themes of experience were achieved through an in-depth phenomenological approach. Although, similarities in experiences compared to other patient groups exist, the precarious situation constituted by COVID-19 lead to significant intensifications across multiple parameters.

Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic

BACKGROUND

Support for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave  support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences.

METHODS

We performed a cross-sectional multicentre cohort study in six Dutch ICUs in the Netherlands. Written questionnaires were distributed among relatives of ICU patients from pre-COVID-19, the first wave and the second wave. The questionnaire included questions on demographics, the organisation of support, and the experiences and satisfaction of relatives with the support.

RESULTS

A total of 329 relatives completed the questionnaire (52% partner, 72% woman and 63% ICU stay of 11 days or longer). Support for relatives of ICU patients during the first COVID-19 wave differed significantly from pre-COVID-19 and the second wave. Differences were found in all categories of elements of support: who, when, how and what. Overall, relatives from the three time periods were very positive about the support. The only difference in satisfaction between the three time periods, was the higher proportion of relatives indicating that healthcare professionals had enough time for them during the first wave. Elements of support which were associated with many positive experiences and satisfaction were: fixed timeslot, receiving information (e.g. leaflets) on ≥ 2 topics, discussing > 5 topics with healthcare professionals, and being offered emotional support.

CONCLUSIONS

Although, support for relatives in the ICU changed considerably during the COVID-19 pandemic, relatives were still positive about this support. The altered support gave insight into avenues for improvement for future comparable situations as well as for normal daily ICU practice: e.g. daily contact at a fixed timeslot, offering video calling between patients and relatives, and offering emotional support. ICUs should consider which elements need improvement in their practice.

Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study

BACKGROUND

Family member presence in the intensive care unit is important for patient well-being and recovery. Limitations to visits increase the risk of psychological distress in family members. During the COVID-19 pandemic, in-person visiting restrictions were introduced to prevent the spread of infection.

PURPOSE

To explore the experience of in-person visiting restrictions imposed during the pandemic on family members of patients with COVID-19 admitted to an intensive care unit.

METHOD

Qualitative method with thematic analysis. Individual semi-structured telephone interviews were conducted.

FINDINGS

We interviewed 21 family members. The results are presented in one overall theme with two main themes and five sub-themes. The theme 'Striving for closeness even at a distance describes the experience of being kept at a physical distance when participants needed closeness the most. Even participants who were allowed in-person visits perceived a 'distance' due to personal protective equipment or because they could only view the patient from a window. Participants reported that contact with and information about the patient was of utmost importance. Visits were viewed as essential in providing for the patient's wellbeing. Meaningful contact with the ICU team was vital for getting useful information. Phone calls became a lifeline, with digital aids such as video calls used occasionally to overcome the feeling of distance.

CONCLUSION

Visiting restrictions imposed during the COVID-19 pandemic made straightforward and comprehensible communication of information from the ICU team more essential to reduce family members' perceptions of distance and exclusion from the intensive care unit.

Interventions using digital technology to promote family engagement in the adult intensive care unit: An integrative review

BACKGROUND

Family engagement is a key component of safe and effective care in the intensive care unit (ICU). As the COVID-19 pandemic has accelerated the adoption of digital technologies in healthcare settings, it is important to review the current science of family engagement interventions in the ICU using digital technology.

OBJECTIVES

This integrative review aimed to identify and evaluate studies that used digital technology to promote family engagement in adult ICUs and synthesize study findings.

METHODS

Following the methodology of Whittemore and Knafl, PubMed, CINAHL, Web of Science, and Scopus were searched. We included studies conducted in the adult ICU setting; involved family engagement during ICU stay; and used digital technology to engage family members. We excluded studies that were not peer-reviewed or in English. Study findings were assessed using the model of family engagement in the ICU RESULTS: Of 2702 articles, 15 articles were analyzed. Various technologies (e.g., web-, tablet-, or SMS-based tools, video-conferencing, etc.) were used to provide information; augment the decision-making process; provide virtual access to family conferences or interdisciplinary rounds. While varying among interventions, "Information sharing" and "activation and participation" were most commonly addressed within the family engagement model. In studies that addressed the components of family engagement more comprehensively, interventions enabled tailoring of information with two-way communication and active family involvement in decision-making processes.

CONCLUSIONS

Future research should use more robust methods and develop interventions with close inputs from families. We recommend using conceptual components of family engagement to ensure comprehensiveness of the intervention.

Psychological Morbidity After COVID-19 Critical Illness

Survivors of ICU hospitalizations often experience severe and debilitating symptoms long after critical illness has resolved. Many patients experience notable psychiatric sequelae such as depression, anxiety, and posttraumatic stress disorder (PTSD) that may persist for months to years after discharge. The COVID-19 pandemic has produced large numbers of critical illness survivors, warranting deeper understanding of psychological morbidity after COVID-19 critical illness. Many patients with critical illness caused by COVID-19 experience substantial post-ICU psychological sequelae mediated by specific pathophysiologic, iatrogenic, and situational risk factors. Existing and novel interventions focused on minimizing psychiatric morbidity need to be further investigated to improve critical care survivorship after COVID-19 illness. This review proposes a framework to conceptualize three domains of risk factors (pathophysiologic, iatrogenic, and situational) associated with psychological morbidity caused by COVID-19 critical illness: (1) direct and indirect effects of the COVID-19 virus in the brain; (2) iatrogenic complications of ICU care that may disproportionately affect patients with COVID-19; and (3) social isolation that may worsen psychological morbidity. In addition, we review current interventions to minimize psychological complications after critical illness.

Family Satisfaction in Intensive Care during the COVID-19 Pandemic Using the FS-ICU24 Questionnaire

INTRODUCTION

The COVID-19 pandemic caused an abrupt change in the pattern of communication involving patients, family members, and healthcare professionals. This study aimed to evaluate family member satisfaction with intensive care units (ICU) care and communication strategies during the COVID-19 pandemic. Secondary objectives included identification of areas requiring improvement, and assessment of the impact of both COVID-19 diagnosis and in-person visits on overall satisfaction.

MATERIAL AND METHODS

A prospective, observational single-center study was conducted among family members of ICU patients admitted between March and September 2020. During this period, ICU visiting policies suffered changes, ranging from full restrictions to eased limitations, which impacted ICU communication procedures and patient contact with family members. Three months after ICU discharge, the designated family members of patients were contacted and invited to fill in a questionnaire that assessed family satisfaction using a Likert response scale.

RESULTS

There was a total of 168 family members contacted (response rate of 57.7%). Most participants were globally satisfied with the care provided by the ICU staff and, apart from communication between nurses and family members, all other questions scored a satisfaction rate above 80%. The study found a statistically significant association between satisfaction and the consistency of clinical information provided and the possibility of having visits (p = 0.046). The odds ratio of being satisfied with information consistency was found to be 0.22 times lower in family members that were able to visit the patient in the ICU during the COVID-19 pandemic [OR = 0.22 (95% CI: 0.054 - 0.896)] compared with families that were unable to presential visit their family member. No statistically significant differences were found in the satisfaction rates between COVID-19 and non-COVID-19 admissions.

CONCLUSION

This is one of the first studies to assess satisfaction among family members of ICU patients during COVID-19 restrictions and the first, as far as we know, performed in the Portuguese population. The overall satisfaction levels were similar to the estimates found in previous studies. A lower degree of satisfaction with information consistency was found in family members who had in-person visits, possibly related with heterogeneity of senior doctors delivering information. COVID-19 diagnosis was not associated with decreased satisfaction.

Fundamental drivers of nurses' experiences of ICU surging during the coronavirus disease 2019 (COVID-19) pandemic

PURPOSE OF REVIEW

Nurses working in intensive care units have been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. This review summarizes the current state of the evidence regarding intensive care nurses experience of the pandemic.

RECENT FINDINGS

The pandemic has had an impact on: nursing workload, the organization of nurse staffing, experiences of staff redeployed into ICU, nurses' perceptions of the safety and quality of patient care, and staff health. In the few comparative studies, mental health was worse for nurses than other healthcare workers in intensive care. Despite some of this evidence being published early in the pandemic, no studies were found to evaluate interventions to improve nurses' experiences.

SUMMARY IMPLICATIONS FOR PRACTICE OR RESEARCH

Many of the adverse impacts of the pandemic are interdependent; for example, reducing nurses' workload is likely to have benefits for mental health indicators.Adverse mental health outcomes are likely to have an impact on future recruitment and retention for intensive care nursing.More studies are needed to understand the longer term impact of the pandemic on intensive care nurses.

The Effect of Hospital Visitor Policies on Patients, Their Visitors, and Health Care Providers During the COVID-19 Pandemic: A Systematic Review

Health care policymaking during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has questioned the precedent of restricting hospital visitors. We aimed to synthesize available data describing the resulting impact on patient, family/visitor, and health care provider well-being. We systematically reviewed articles from the World Health Organization COVID-19 Global Literature on Coronavirus Disease Database published between December 2019 through April 2021. Included studies focused on hospitalized patients and reported 1 or more prespecified main or secondary outcome (coronavirus disease 2019 [COVID-19] disease transmission, global well-being, mortality, morbidity, or health care resource utilization). Two authors independently extracted data into a standardized form with a third author resolving discrepancies. A total of 1153 abstracts were screened, and 26 final full-text articles were included. Ten studies were qualitative, with 7 cohort studies, and no randomized controlled trials. Critically ill patients were the most represented (12 out of 26 studies). Blanket hospital visitor policies were associated with failure to address the unique needs of patients, their visitors, and health care providers in various clinical environments. Overall, a patient-centered, thoughtful, and nuanced approach to hospital visitor policies is likely to benefit all stakeholders while minimizing potential harms.

Perspectives from designated family caregivers of critically ill adult patients during the COVID-19 pandemic: A qualitative interview study

Background

Family visitation in intensive care units (ICU) has been impacted by the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic. While studies report on perceptions of families completely restricted from ICUs, little is known about the burden experienced by designated family caregivers allowed to visit their critically ill loved one. This study sought the perspectives of family caregivers of critically ill patients on the impact of one-person designated visitor policies mandated in ICUs during the COVID-19 pandemic.

Methods

Throughout the study period a restricted visitation policy was mandated capturing the first (April 2020) and second (December 2020) waves of the pandemic that allowed one designated family caregiver (i.e., spouses or adult children) per patient to visit the ICU. Designated family caregivers of critically ill patients admitted to ICU September 2020 to November 2020 took part in individual 60-minute, semi-structured interviews at 6-months after discharge from the index ICU admission. Themes from family interviews were summarized with representative quotations.

Results

Key themes identified following thematic analysis from six participants included: one visitor rule, patient advocate role, information needs, emotional distress, strategies for coping with challenges, practicing empathy, and appreciation of growth.

Conclusion

Designated family caregivers of critically ill patients admitted to ICU during the COVID-19 pandemic perceived a complex and highly stressful experience. Support from ICU family liaisons and psychologists may help ameliorate the impact.

Video calls did not reduce PTSD symptoms in relatives during restricted ICU visits in the COVID-19 pandemic

To help reduce the spread of the SARS-CoV-2 virus during the COVID-19 pandemic, ICU visits were banned or restricted. Therefore, family-centered care as usually practiced was not feasible Video calls were recommended to meet relatives’ needs. The aim of this study was to investigate the effect of video calls on symptoms of post-traumatic stress disorder (PTSD) in relatives of ICU patients. This single-center study was performed during the first wave (15.03.2020‒30.04.2020; visits banned) and the second wave (01.10.20‒08.02.21: visits restricted) of the COVID-19 pandemic. The Impact of Event Scale-Revised (IES-R) was used to assess PTSD symptoms and an adapted version of the Family Satisfaction in the Intensive Care Unit 24-Item-Revised questionnaire (aFS-ICU 24R) to assess family satisfaction 3 months after ICU stay. The primary outcome was the difference in IES-R score at 3 months between the video call group (VCG) and the standard care group (SCG, no video calls). In addition, inductive content analysis of relatives’ comments regarding their satisfaction with decision-making and ICU care was performed. Fifty-two relatives (VCG: n = 26, SCG: n = 26) were included in this study. No significant difference in IES-R scores was observed between the VCG and the SCG (49.52 ± 13.41 vs. 47.46 ± 10.43, p = 0.54). During the ICU stay (mean 12 days, range 5.25‒18.75 days), the members of the VCG made a median of 3 (IQR 1‒10.75) video calls. No difference between the groups was found for conventional telephone calls during the same period (VCG: 9 calls, IQR 3.75‒18.1; SCG: 5 calls, IQR 3‒9; p = 0.12). The aFS-ICU 24R scores were high for both groups: 38 (IQR 37‒40) in the VCG and 40 (IQR 37‒40: p = 0.24) in the SCG. Video calls appeared largely ineffective in reducing PTSD symptoms or improving satisfaction among relatives affected by banning/restriction of ICU visits during the COVID-19 pandemic. Further investigations are needed to acquire more data on the factors involved in PTSD symptoms experienced by relatives of ICU patients during the COVID-19 pandemic.

Psychological distress and morbidity of family members experiencing virtual visiting in intensive care during COVID-19: an observational cohort study

Purpose

During the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world introduced virtual visiting to mediate the psychological impact of in-person visiting restrictions. Our objective was to evaluate levels of distress, depression, anxiety, and stress among family members experiencing virtual visits.

Methods

Multi-centre prospective observational study recruiting adult family members of critically ill patients in the United Kingdom (UK) using a bespoke virtual visiting solution (aTouchAway). We recruited participants and administered validated questionnaires digitally via their aTouchAway account. Prior to first virtual visit, participants completed the Distress Thermometer (score range 0–10) and the Depression, Anxiety and Stress Scale (DASS)-21. Following first and subsequent virtual visits, participants repeated the Distress Thermometer and completed the Discrete Emotions Questionnaire.

Results

We recruited 2166 adult family members of ICU patients in 37 UK hospitals. Most were grown up children (33%) or spouses/partners (23%). Most (91%) were ≤ 65 years. Mean (SD) pre-virtual-visit Distress Thermometer score was 7 (2.6) with 1349/2153 (62%) reporting severe distress. Pre-visit Distress Thermometer scores were associated with relationship type (spouse/partner OR 1.65, 95% CI 1.27–2.12) but not family member age, or length of ICU stay. Mean (SD) post-visit Distress Thermometer score provided by 762 (35%) participants was 1.6 (3.2) points lower than pre-visit (P < 0.001). Of participants experiencing multiple visits, 22% continued to report severe distress. Median (IQR) pre-visit DASS-21 score was 18 (2–42) (1754 participants). Severe-to-extremely severe depression, anxiety, or stress were reported by 249 (14%), 321 (18%), and 165 (9%) participants, respectively. Participants reported a range of emotions with reassurance being the most common, anger being the least.

Conclusion

Family members exposed to COVID-19 pandemic ICU visiting restrictions experienced severe distress. One fifth of family members reported severe-to-extremely sever anxiety or depression. Distress score magnitude and prevalence of severe distress decreased after undertaking one or more virtual visits.

A multicomponent family support intervention in intensive care units: study protocol for a multicenter cluster-randomized trial (FICUS Trial)

Background

Family members of critically ill patients face considerable uncertainty and distress during their close others’ intensive care unit (ICU) stay. About 20–60% of family members experience adverse mental health outcomes post-ICU, such as symptoms of anxiety, depression, and posttraumatic stress. Guidelines recommend structured family inclusion, communication, and support, but the existing evidence base around protocolized family support interventions is modest and requires substantiation.

Methods

To test the clinical effectiveness and explore the implementation of a multicomponent, nurse-led family support intervention in ICUs, we will undertake a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 1 trial. It will include eight clusters (ICUs) per study arm, with a projected total sample size of 896 family members of adult, critically ill patients treated in the German-speaking part of Switzerland. The trial targets family members of critically ill patients with an expected ICU stay of 48 h or longer. Families in the intervention arm will receive a family support intervention in addition to usual care. The intervention consists of specialist nurse support that is mapped to the patient pathway with follow-up care and includes psycho-educational and relationship-focused family interventions, and structured, interprofessional communication, and shared decision-making with families. Families in the control arm will receive usual care. The primary study endpoint is quality of family care, operationalized as family members’ satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and family members’ mental health (well-being, psychological distress) measured at admission, discharge, and after 3, 6, and 12 months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference.

Discussion

This trial will examine the effectiveness of the family support intervention and generate knowledge of its implementability. Both types of evidence are necessary to determine whether the intervention works as intended in clinical practice and could be scaled up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being.

Trial registration

ClinicalTrials.gov NCT05280691. Prospectively registered on 20 February 2022.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06454-y.

Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

BACKGROUND

During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions.

METHODS

A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave.

RESULTS

Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0-6]%, 0 [0-4]% and 11 [2-25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic.

CONCLUSIONS

Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted.

Family-centred care of patients admitted to the intensive care unit in times of COVID-19: A systematic review

OBJECTIVES

To describe clinical practice interventions aimed at providing Family-Centred Care in intensive care units during the COVID-19 pandemic.

RESEARCH METHODOLOGY

A systematic review was carried out following the PRISMA recommendations in various databases: PubMed, Cinahl, Web of Science, Scopus, and Google Scholar were consulted, as well as within the grey literature found on the web pages of official organizations related to Intensive Care Medicine and Nursing.

SETTING

Adult intensive care unit.

RESULTS

The search yielded 209 documents of which 24 were included in this review: eight qualitative studies, seven protocols and recommendations from official bodies, one mixed-method studies, five descriptive studies, one cross-sectional study, one pilot program and one literature review. A thematic analysis revealed four major themes: the use of communication systems, multidisciplinary interventions; the promotion of family engagement and family support. The results show different strategies that can be implemented in clinical practice to solve the difficulties encountered in Family-Centred Care in critical care units during the COVID-19 pandemic.

CONCLUSIONS

There is a great variety in the nature of the interventions developed, with the use of telecommunication systems in daily practice being the most repeated aspect. Future research should aim to assess whether the interventions implemented increase the quality of patient and family care by meeting their needs.

The end of life of patients with COVID-19 in intensive care unit and the stress level on their family members: A cross-sectional study

BACKGROUND

During the Coronavirus disease 2019 (COVID-19) pandemic, hospital visits were suspended and video calls were offered to connect patients with their family members, especially toward the end of life (EoL).

AIM

The primary aim was to describe EoL care for COVID-19 patients dying in an intensive care unit (ICU). The secondary aim was to explore whether making video calls and allowing visits was associated with lower death-related stress in family members.

DESIGN

Single centre cross-sectional study. The setting was the ICU of a COVID-19 center in northern Italy, during the first year of the pandemic. Data on patients who died in the ICU were collected; death-related stress on their family members was measured using the Impact of Event Scale-Revised (IES-R). The statistical association was tested by means of logistic regression.

RESULTS

The study sample included 70 patients and 56 family members. All patients died with mechanical ventilation, hydration, nutrition, analgesia and sedation ongoing. Resuscitation procedures were performed in 5/70 patients (7.1%). Only 6/56 (10.7%) of the family members interviewed had visited their loved ones in the ICU and 28/56 (50%) had made a video call. EoL video calls were judged useful by 53/56 family members (94.6%) but all (56/56, 100%) wished they could have visited the patient. High-stress levels were found in 38/56 family members (67.9%), regardless of whether they were allowed ICU access or made a video call. Compared with other degrees of kinship, patients' offspring were less likely to show a positive IES-R score (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.05 to 0.89).

CONCLUSIONS

During the first year of the COVID-19 pandemic, patients died without their family members at the bedside while on life-sustaining treatment. Stress levels were high in most family members, especially in patients' spouses. Video calls or ICU visits were judged favourably by family members but insufficient to alleviate death-related stress.

RELEVANCE FOR CLINICAL PRACTICE

During a pandemic, ICU access by patients' family members should be considered, particularly as the time of death approaches. Although generally appreciated by family members, EoL video calls should be arranged together with other measures to alleviate death-related stress, especially for the patient's spouse.

Family perspectives on facilitators and barriers to the set up and conduct of virtual visiting in intensive care during the COVID-19 pandemic: a qualitative interview study

Objective

Methods

Results

Conclusion

Comparison of clinicians' perceptions of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) before and during the COVID-19 pandemic

Introduction

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process encourages collaboration between clinicians, patients, and relatives on emergency care wishes and resuscitation decisions. The impact of the COVID-19 pandemic on clinicians’ views of the ReSPECT process was unknown. We examined whether there were changes in clinicians’ knowledge, skills, and attitudes regarding ReSPECT during the pandemic.

Methods

We conducted a cross-sectional survey of clinicians at one acute hospital in the UK. We developed a questionnaire with a defined 5-point Likert scale and asked clinicians to recall their pre-pandemic views on ReSPECT and report their current views at the time of survey distribution (May 2020, end of the first COVID-19 wave in the UK). We compared their self-reported views before and during the pandemic.

Results

We analysed 171 questionnaire responses. Clinicians reported ReSPECT telephone discussions with relatives were more challenging (pre-pandemic median 4, IQR 3–4; during pandemic median 4, IQR 4–5; p < 0.001) and negative emotions whilst conducting these discussions with relatives increased during the pandemic (pre-pandemic median 3, IQR 2–3.5; during pandemic median 3, IQR 2–4; p < 0.001). Clinicians also reported an increase in the importance of reaching a shared understanding of decisions with patients and relatives (pre-pandemic median 4, IQR 4–5; during pandemic median 5, IQR 4–5; p < 0.001).

Conclusions

There were differences in clinicians’ knowledge, skills, and attitudes scores before and during the pandemic. Our findings highlighted that clinicians could benefit from training in remote ReSPECT conversations with relatives.

The parental psychological distress caused by separation from their critically ill child during the COVID-19 pandemic: A tale of two cities

INTRODUCTION

A child's critical illness is a stressful event for the entire family, causing significant emotional distress among parents and changes to family functioning. The Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2) pandemic has abruptly caused modifications in visitation policies of Pediatric Intensive Care Units (PICUs) in many countries. We hypothesized that caregivers with no or severely restricted access to PICUs would demonstrate increased psychological distress as compared to those who had limitless access (LA) to PICUs.

METHODS

Sociodemographic variables, levels of psychological distress, ratings of family functioning, and ability to cope with stressful events were collected with an online survey in a group of caregivers after their child's hospitalization. Ratings of psychological distress were compared between caregivers with no/severely restricted (NA) and with LA to PICUs.

RESULTS

Measures of depression, anxiety, and global severity index (GSI) of psychological distress were significantly higher in NA caregivers as compared to LA. Among demographic characteristics of the sample, only gender influenced the severity of psychological symptoms: women showed an increased score on levels of somatization, depression, anxiety, and GSI. Avoidant coping style positively correlated with measures of depression. Univariate General Linear Model (GLM) analyses of the effects of sex, age, visitation policies of PICUs, and score of avoidant coping strategies on measures of psychological distress confirmed a significant univariate effect of no access to PICUs on parents' psychopathological scores.

CONCLUSION

Restrictions imposed on visitation policies in PICU during the pandemic negatively impacted families' psychological wellbeing. A balance between the safety of patients, families, and health care professionals and meeting the needs of families is of utmost importance.

Nurse perceptions of a nurse family liaison implemented during the COVID-19 pandemic: A qualitative thematic analysis

Objective

Stress among family members of hospitalised intensive care unit patients may be amplified in the context of a global pandemic and strict visitor restrictions. A nurse family liaison role in the COVID-19 units was implemented to serve as a connection between the care team and a designated family member. Our objective was to describe the experience of a nurse family liaison role implemented during the COVID-19 pandemic from the perspective of nurses who functioned in the liaison role and intensive care nurses who worked with the liaisons.

Research method/design

This was a qualitative study using thematic analysis involving a one-time semi-structured interview. A convenience sample of nurses were invited to participate. The analytic approach involved (1) becoming familiar with the data; (2) finding meaning in the data; (3) organising meaningful statements into patterns to generate themes.

Setting/participants

Nurses who functioned in the liaison role and intensive care nurses who worked with the liaisons in an adult academic health center in the Midwest United States.

Main outcome measure

To describe the psychosocial experience of nurse family liaison role implementation.

Findings

The sample (n = 11) mean age was 36 years (range 26–49) and the majority were female (n = 10; 90%), White/non-Hispanic (n = 11; 100%), Bachelor prepared (n = 10; 90%), and had an average of 10 years of experience as a nurse (range 4–25). The major themes identified by participants were living in a pandemic, establishing the role and workflow and experiencing human connection.

Conclusion

Hospital organisations should consider how they can provide family-centred care, specifically within the context of a global crisis such as a pandemic. Participant descriptions of the role indicate that liaison implementation alleviated nurse moral distress and fostered development of close family connections. Findings can help inform implementation of similar roles in hospital settings.

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

AIM AND OBJECTIVES

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

BACKGROUND

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

DESIGN

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

RESULTS

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

CONCLUSION

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

RELEVANCE FOR CLINICAL PRACTICE

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

Impact of COVID-19 Pandemic on Pediatric Intensive Care Unit (PICU) Visiting Policies: A Worldwide Survey

The purpose of this study was to evaluate pediatric intensive care unit (PICU) visiting policies around the world and how the coronavirus disease 2019 (COVID-19) pandemic has affected these policies, due to concerns relating to a viral transmission. A web-based international survey was designed and disseminated through social networks, emails, or direct messages. Two hundred forty-one answers were received. From these, 26 were excluded (13 due to missing location and 13 duplicated answers), resulting in a final number of 215 answers. Europe accounted for 35% of responses (n = 77), South America 22.4% (n = 49), North America 19% (n = 41), Asia 16.5% (n = 36), Central America 2.7% (n = 6), Oceania, and Africa 2.2% each (n = 5 each). Before the pandemic, reported admission/visiting policies already varied between continents. Family time schedules remained similar to the pre-pandemic period in half of European, Central, and South American units and have changed in 60% of Asian, African, North American, and Oceanian units. Access to PICUs has been granted for patients and caregivers tested negative for severe acute respiratory syndrome coronavirus 2 (SARS COV-2) in only part of studied PICUs. Isolation precautions for the visitors were intensified at the onset of the pandemic. Changes in visiting policies were observed in most PICUs worldwide during the COVID-19 pandemic, with some PICUs prohibiting any visitation by families. These changes can decrease possibilities of parental participation in emotional support and reduction of sedation needs, early mobility, and shared decision-making process and impact negatively both children and parental well-being and even patients' outcomes.

A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic

To create evidence-based consensus statements for restricted ICU visitation policies to support critically ill patients, families, and healthcare professionals during current and future pandemics.

DESIGN

Three rounds of a remote modified Delphi consensus process.

SETTING

Online survey and virtual polling from February 2, 2021, to April 8, 2021.

SUBJECTS

Stakeholders (patients, families, clinicians, researchers, allied health professionals, decision-makers) admitted to or working in Canadian ICUs during the coronavirus disease 2019 pandemic.

MEASUREMENTS AND MAIN RESULTS

During Round 1, key stakeholders used a 9-point Likert scale to rate experiences (1-not significant, 9-significant impact on patients, families, healthcare professionals, or patient- and family-centered care) and strategies (1-not essential, 9-essential recommendation for inclusion in the development of restricted visitation policies) and used a free-text box to capture experiences/strategies we may have missed. Consensus was achieved if the median score was 7-9 or 1-3. During Round 2, participants used a 9-point Likert scale to re-rate experiences/strategies that did not meet consensus during Round 1 (median score of 4-6) and rate new items identified in Round 1. During Rounds 2 and 3, participants ranked items that reached consensus by order of importance (relative to other related items and experiences) using a weighted ranking system (0-100 points). Participants prioritized 11 experiences (e.g., variability of family's comfort with technology, healthcare professional moral distress) and developed 21 consensus statements (e.g., communicate policy changes to the hospital staff before the public, permit visitors at end-of-life regardless of coronavirus disease 2019 status, creating a clear definition for end-of-life) regarding restricted visitation policies.

CONCLUSIONS

We have formulated evidence-informed consensus statements regarding restricted visitation policies informed by diverse stakeholders, which could enhance patient- and family-centered care during a pandemic.

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

Intensive care unit survivors experience prolonged physical impairments, cognitive impairments, and mental health problems, commonly referred to as post-intensive care syndrome (PICS). Previous studies reported the prevalence, assessment, and prevention of PICS, including the ABCDEF bundle approach. Although the management of PICS has been advanced, the outbreak of coronavirus disease 2019 (COVID-19) posed an additional challenge to PICS. The prevalence of PICS after COVID-19 extensively varied with 28-87% of cases pertaining to physical impairments, 20-57% pertaining to cognitive impairments, and 6-60% pertaining to mental health problems after 1-6 months after discharge. Each component of the ABCDEF bundle is not sufficiently provided from 16% to 52% owing to the highly transmissible nature of the virus. However, new data are emerging about analgesia, sedation, delirium care, nursing care, early mobilization, nutrition, and family support. In this review, we summarize the recent data on PICS and its new challenge in PICS after COVID-19 infection.

Workaholism, sleep disorders, and potential e-learning impacts among Menoufia university staff during COVID-19 pandemic

BACKGROUND

Workaholism is described as a constant, internal drive to work and behavioral addiction to work. Studies have shown the negative associations between workaholism, job performance, and health results as disrupted sleep. The purpose of this research was to compare the prevalence of workaholics among the academic staff of practical and theoretical Faculties in Egyptian universities using the Dutch Workaholism Scale (DUWAS) and to determine associated sleep problems. Also, it studied the added impact of E-learning on the prevalence of workaholism frequency during the COVID-19 pandemic.

DESIGN AND METHODS

A cross-sectional study was conducted among 336 participants. Work addiction was assessed using DUWAS (17 items) as well as questionnaires on personal, occupational characteristics, and sleep problems. DUWAS scale was repeated after six months during COVID 19 pandemic to investigate the impact of E-learning on the workaholic behavior of the studied groups.

RESULTS

Our study revealed that the prevalence of workaholism was 33 percent. 32.8% and 33.7% were listed for the faculties of Medicine and Arts, respectively. After the COVID-19 pandemic, workaholic frequency was significantly increased to be 46.4%. Adjusted logistic regression analysis showed that workaholism had negatively impacted sleep in terms of difficulty initiating sleep, difficulty maintaining sleep, and insufficient sleep.

CONCLUSION

The prevalence of workaholism appears to be high among university staff members especially after COVID-19 crisis. Sleep problems were linked to workaholics more than other workers. We recommend encouraging employees to work to their contracted hours, as excess work over extended periods may have adverse effects not only on organizational productivity but also on their health.