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Papautsky EL, Abdulbaseer U. Capturing the Work of Patients' Family Members in the Medical Intensive Care Unit Using Naturalistic Observations. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:84-91. [PMID: 37553816 DOI: 10.1177/19375867231190620] [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] [Indexed: 08/10/2023]
Abstract
BACKGROUND The contributions of cognitive and behavioral work of patients' family members in intensive care units remain largely unrecognized. OBJECTIVE The objective of this study was to develop a framework of outwardly observable family work, with specific focus on describing the physical space. METHODS We conducted approximately 50 hrs of naturalistic observations of family activities on a medical intensive care unit (MICU) at a large, Midwestern teaching hospital. RESULTS We created a framework of activities that include requesting, receiving, or delivering either information or action, along with examples. Further, we identified clinician and staff roles with whom families interact and characterized the physical spaces in which interactions take place. CONCLUSIONS Knowledge contribution is a proposed framework of family activities in the MICU. It has the potential to guide and be further described by future research and to inform development of human-centered family-facing interventions to support cognitive and behavioral cognitive and behavioral work.
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Harris BRE, Butler A, Hirshberg EL, Hopkins RO, Butler J, Orme J, Brown SM, Beesley SJ. Trainees' Experience of Family Presence during Intensive Care Unit Procedures. ATS Sch 2023; 4:469-473. [PMID: 38196675 PMCID: PMC10773269 DOI: 10.34197/ats-scholar.2023-0065br] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/17/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
| | | | - Eliotte L. Hirshberg
- Pulmonary Division, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Center for Humanizing Critical Care, Intermountain Healthcare, Salt Lake City, Utah
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah
| | - Ramona O. Hopkins
- Center for Humanizing Critical Care, Intermountain Healthcare, Salt Lake City, Utah
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
| | - Jorie Butler
- Center for Humanizing Critical Care, Intermountain Healthcare, Salt Lake City, Utah
- Geriatrics Division, Department of Internal Medicine, and
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | - James Orme
- Pulmonary Division, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Center for Humanizing Critical Care, Intermountain Healthcare, Salt Lake City, Utah
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah
| | - Samuel M. Brown
- Pulmonary Division, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Center for Humanizing Critical Care, Intermountain Healthcare, Salt Lake City, Utah
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah
| | - Sarah J. Beesley
- Pulmonary Division, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Center for Humanizing Critical Care, Intermountain Healthcare, Salt Lake City, Utah
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Salt Lake City, Utah
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Solomon J, Goldfarb M. Family engagement in care for medical trainees and early career clinicians. BMC MEDICAL EDUCATION 2023; 23:811. [PMID: 37891560 PMCID: PMC10605966 DOI: 10.1186/s12909-023-04792-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Engaging family members in care improves person- and family-centered outcomes. Many healthcare professionals have limited awareness of the role and potential benefit of family engagement in care. This review describes the rationale for engaging families in care, and opportunities to engage family in various clinical care settings during training and early career practice.
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Affiliation(s)
- Joshua Solomon
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Michael Goldfarb
- Azrieli Heart Centre, Division of Cardiology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Office E-212, H3T 1E2, Montreal, QC, Canada.
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Shahid A, Johnstone C, Sept BG, Kupsch S, Soo A, Fiest KM, Stelfox HT. Family coaching during Spontaneous Awakening Trials and Spontaneous Breathing Trials (FamCAB): pilot study protocol. BMJ Open 2023; 13:e068770. [PMID: 36806132 PMCID: PMC9943692 DOI: 10.1136/bmjopen-2022-068770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Many patients in the intensive care unit (ICU) require weaning from deep sedation (Spontaneous Awakening Trials, SATs) and mechanical ventilation (Spontaneous Breathing Trials, SBTs) in their journey to recovery. These procedures can be distressing for patients and their families. The presence of family members as 'coaches' during SATs/SBTs could provide patients with reassurance, reduce stress for patients and families and potentially improve procedural success rates. METHODS AND ANALYSIS This study will be executed in two phases:Development of a coaching module: a working group including patient partners (i.e., former ICU patients or family members of former ICU patients), researchers, and ICU clinicians will develop an educational module on family coaching during SATs/SBTs (FamCAB). This module will provide families of critically ill patients basic information about SATs/SBTs as well as coaching guidance.Pilot testing: family members of ICU patients will complete the FamCAB module and provide information on: (1) demographics, (2) anxiety and (3) satisfaction with care in the ICU. Family members will then coach the patient through the next clinically indicated SATs and/or SBTs. Information around duration of time and success rates of SATs and/or SBTs (ability to conduct a complete assessment) alongside feedback will be collected. ICU clinical staff (including physicians and nurses) will be asked for feedback on practicality and perceived benefits or drawbacks of family coaching during these procedures. Feasibility and acceptability of family coaching in SATs/SBTs will be determined. DISCUSSION The results of this work will inform whether a larger study to explore family coaching during SATs/SBTs is warranted. ETHICS AND DISSEMINATION This study has received ethical approval from the University of Calgary Conjoint Health Research Ethics Board. Results from this pilot study will be made available via peer-reviewed journals and presented at critical care conferences on completion.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Corson Johnstone
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- Department of Psychiatry, Hotchkiss Brain Institute, and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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5
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de Mingo-Fernández E, Belzunegui-Eraso Á, Medina-Martín G, Cuesta-Martínez R, Tejada-Musté R, Jiménez-Herrera M. Family presence during invasive procedures: a pilot study to test a tool. BMC Health Serv Res 2022; 22:1583. [PMID: 36572919 PMCID: PMC9791719 DOI: 10.1186/s12913-022-08876-5] [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: 11/08/2021] [Accepted: 11/23/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Family Presence During Invasive Procedures (FPDI) generates controversy among healthcare professionals. Twibell and her team designed an instrument that measured nurses' Risk-Benefit and Self-Confidence perceptions regarding family presence during resuscitation and was used in numerous studies. OBJECTIVES Evaluate the new tool for Family Presence Risk-Benefit and Family Presence Self-Confidence during invasive procedures and find out the opinions of the medical and nursing staff on FPDIP. METHOD Cross-sectional methodological pilot study. Online and paper questionnaires modified from a previous translation. A factor analysis was performed for the validity of the indices and bivariate analysis for all the variables. Ethical approvals and research permissions were obtained according to national standards. RESULTS One hundred twenty healthcare professionals (22.18%) answered the survey. Cronbach's α on the Family Presence Risk-Benefit scale was 0.877. Cronbach's α on the Family Presence Self-Confidence scale was 0.937. The correlation between the Risk-Benefit and Self-confidence variables is significant and with a moderate intensity of the relationship. A lower predisposition to Family Presence During Invasive Procedures is observed. Physicians are more reluctant than nurses. CONCLUSIONS The FPDI generates controversy as it alters health professionals' routines when they decide whether to allow it or not. There is a tendency for younger professionals to support FPDI. In general, health professionals, mainly physicians, do not favor FPDI. Health workers who perceive fewer risks and more benefits in FPDI and have greater self-confidence are more in favor of FPDI. The psychometric properties and internal consistency of the questionnaire indicate the validity and reliability of this tool.
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Affiliation(s)
- Eva de Mingo-Fernández
- grid.410367.70000 0001 2284 9230Departament d’Infermeria (Nursing Department), Universitat Rovira i Virgili, Tarragona, Spain ,Consorci Sanitari del l’Alt Penedès i Garraf. (CSAPG), Barcelona, Spain
| | - Ángel Belzunegui-Eraso
- grid.410367.70000 0001 2284 9230Departament estadística (Statistics Department), Universitat Rovira i Virgili, Tarragona, Spain
| | - Guillermina Medina-Martín
- grid.410367.70000 0001 2284 9230Departament d’Infermeria (Nursing Department), Universitat Rovira i Virgili, Tarragona, Spain
| | - Roser Cuesta-Martínez
- grid.410367.70000 0001 2284 9230Departament d’Infermeria (Nursing Department), Universitat Rovira i Virgili, Tarragona, Spain
| | - Raquel Tejada-Musté
- grid.410367.70000 0001 2284 9230Departament d’Infermeria (Nursing Department), Universitat Rovira i Virgili, Tarragona, Spain
| | - María Jiménez-Herrera
- grid.410367.70000 0001 2284 9230Departament d’Infermeria (Nursing Department), Universitat Rovira i Virgili, Tarragona, Spain
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Secunda KE, Kruser JM. Patient-Centered and Family-Centered Care in the Intensive Care Unit. Clin Chest Med 2022; 43:539-550. [PMID: 36116821 PMCID: PMC9885766 DOI: 10.1016/j.ccm.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Patient-centered and family-centered care (PFCC) is widely recognized as integral to high-quality health-care delivery. The highly technical nature of critical care puts patients and families at risk of dehumanization and renders the delivery of PFCC in the intensive care unit (ICU) challenging. In this article, we discuss the history and terminology of PFCC, describe interventions to promote PFCC, highlight limitations to the current model, and offer future directions to optimize PFCC in the ICU.
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Affiliation(s)
- Katharine E Secunda
- Department of Medicine, Division of Pulmonary and Critical Care, University of Pennsylvania
| | - Jacqueline M Kruser
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
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Bordessoule A, Felice-Civitillo C, Grazioli S, Barcos F, Haddad K, Rimensberger PC, Polito A. In situ simulation training for parental presence during critical situations in PICU: an observational study. Eur J Pediatr 2022; 181:2409-2414. [PMID: 35277736 PMCID: PMC9110492 DOI: 10.1007/s00431-022-04425-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/02/2022] [Accepted: 02/18/2022] [Indexed: 02/02/2023]
Abstract
Family presence during invasive procedures or cardiopulmonary resuscitation (CPR) is a part of the family-centered approach in pediatric intensive care units (PICUs). We established a simulation program aiming at providing communication tools to healthcare professionals. The goal of this study was to evaluate the impact of this program on the stress of PICU professionals and its acceptance. An observational study of a simulation program, with questionnaire, was used to measure pre- and post-simulation stress and the degree of satisfaction of the participants. PICU of Geneva Children's Hospital, Switzerland. Forty simulations with four different simulation scenarios and various types of parental behavior, as imitated by professional actors, were completed during a 1-year period. Primary outcomes were the difference in perceived stress level before and after the simulation and the degree of satisfaction of healthcare professionals (nursing assistants, nurses, physicians). The impact of previous experience with family members during critical situations or CPR was evaluated by variation in perceived stress level. Overall, 201 questionnaires were analyzed. Perceived stress associated with parental presence decreased from a pre-simulation value of 6 (IQR, 4-7) to 4 (IQR, 2-5) post-simulation on a scale of 1-10. However, in 25.7% of cases, the individually perceived post-simulation stress level was higher than the pre-simulation one. Satisfaction of the participants was high with a median of 10 (IQR, 9-10) out of 10. CONCLUSIONS A simulation program helps reduce PICU team emotional stress associated with the presence of family members during critical situations or CPR, and is welcomed by PICU team members. WHAT IS KNOWN • Family presence during cardiopulmonary resuscitation (CPR) or critical situations is a part of the family-centered approach in pediatric intensive care. • The benefits for the family have been already demonstrated. However, this policy is still controversy among healthcare professionals. WHAT IS NEW • A simulation program seeking to provide skills focused on family presence management in the PICU is useful to reduce stress and was well accepted by participants. • It might become an indispensable training intervention for the implementation of a PICU policy to allow family presence during CPR or other critical situations.
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Affiliation(s)
- Alice Bordessoule
- Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, University of Geneva, Rue Willy Donze 6, 1205 Geneva, Switzerland
| | - Cristina Felice-Civitillo
- Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, University of Geneva, Rue Willy Donze 6, 1205 Geneva, Switzerland
| | - Serge Grazioli
- Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, University of Geneva, Rue Willy Donze 6, 1205 Geneva, Switzerland
| | - Francisca Barcos
- Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, University of Geneva, Rue Willy Donze 6, 1205 Geneva, Switzerland
| | - Kevin Haddad
- Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, University of Geneva, Rue Willy Donze 6, 1205 Geneva, Switzerland
| | - Peter C. Rimensberger
- Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, University of Geneva, Rue Willy Donze 6, 1205 Geneva, Switzerland
| | - Angelo Polito
- Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, University of Geneva, Rue Willy Donze 6, 1205 Geneva, Switzerland
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Camporesi A, Abecasis F, Torres EM, Zoia E, Izzo F, Ferrario S, Melloni EMT. The parental psychological distress caused by separation from their critically ill child during the COVID-19 pandemic: A tale of two cities. Front Pediatr 2022; 10:909210. [PMID: 36186626 PMCID: PMC9520916 DOI: 10.3389/fped.2022.909210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Francisco Abecasis
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Erica M Torres
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Elena Zoia
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Francesca Izzo
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Stefania Ferrario
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital "Vittore Buzzi", Milan, Italy
| | - Elisa Maria Teresa Melloni
- Psychiatry & Clinical Psychobiology Unit, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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Camporesi A, Zanin A, Kanaris C, Gemma M, Soares Lanziotti V. Impact of COVID-19 Pandemic on Pediatric Intensive Care Unit (PICU) Visiting Policies: A Worldwide Survey. J Pediatr Intensive Care 2021. [DOI: 10.1055/s-0041-1739263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractThe 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.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children's Hospital Vittore Buzzi, Milano, Italy
| | - Anna Zanin
- Department of Women's and Children's Health, Azienda Ospedaliera University of Padua, Padua, Italy
| | - Constantinos Kanaris
- Pediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Pediatric and Neonatal Decision Support and Retrieval Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Blizard Institute Queen Mary University of London, London, United Kingdom
| | - Marco Gemma
- Department of Anesthesia and Intensive Care, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit, Maternal and Child Health, Institute of Pediatrics (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Scanferla E, Gorwood P, Fasse L. Familial experience of acute bacterial meningitis in children: a transversal qualitative study using interpretative phenomenological analysis. BMJ Open 2021; 11:e047465. [PMID: 34285009 PMCID: PMC8292830 DOI: 10.1136/bmjopen-2020-047465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To capture the subjective experience of close family ascendants of acute bacterial meningitis survivors and to explore how they give meaning to this specific experience. DESIGN A qualitative study of indepth interviews using interpretative phenomenological analysis. PRIMARY OUTCOME Main meaning-making processes of participants' experience. SETTINGS Participants were recruited through two associations of people affected by meningitis and their family ascendants. PARTICIPANTS Convenience sampling of 11 women whose children or grandchildren were between 0.2 and 20 years old at the time of their meningitis diagnosis (M=4.06, SD=7.3). On average, 9.39 (SD=5.4) years had passed between the onset of illness and the interview. RESULTS Six superordinate themes (meningitis disease; healthcare services and professionals; knowledge/ignorance; repercussions of the meningitis experience: 'life afterwards'; sick child attitudes/behaviour; and sibling attitudes/behaviour) and two main meaning-making processes in relation to participants' experience of meningitis were identified: (1) the sick child becoming a 'hero': comparison with other children; and (2) engaging action/attitude: finding the 'positive' of the traumatic experience and engaging action to improve the care system. These two processes underpin the psychological adjustment to meningitis and its consequences. CONCLUSIONS This study provides a unique insight into close family members' first-hand experience with acute bacterial meningitis. Findings highlighted factors characterising the disease experience, the psychological adjustment of meningitis survivors' families and their meaning-making processes. These findings are important for research and clinical practice, demonstrating the multidimensional impact of the disease on family ascendants, their need for professional psychological support and the importance of direct involvement of parents in identifying key aspects of care.
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Affiliation(s)
- Elisabetta Scanferla
- CMME (Clinique des Maladies Mentales et de l'Encéphale), GHU Paris psychiatrie et neurosciences, Paris, France
- ED 450, Université de Paris, Paris, France
| | - Philip Gorwood
- CMME (Clinique des Maladies Mentales et de l'Encéphale), GHU Paris psychiatrie et neurosciences, Paris, France
- U1266, INSERM, Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, Paris, France
| | - Léonor Fasse
- LPPS, EA4057, Université de Paris, Paris, France
- Département de Soins de Support, Gustave Roussy Institute, Villejuif, France
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Abdul Halain A, Tang LY, Chong MC, Ibrahim NA, Abdullah KL. Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review. J Clin Nurs 2021; 31:497-507. [PMID: 34254377 DOI: 10.1111/jocn.15962] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To map research-based psychological distress among the family members with patients in the intensive care unit (ICU). BACKGROUND Having a loved one in the ICU is a stressful experience, which may cause psychological distress for family members. Depression, anxiety and stress are the common forms of psychological distress associated with ICU patient's family members. Directly or indirectly, psychological distress may have behavioural or physiological impacts on the family members and ICU patient's recovery. DESIGN The study was based on the five-stage methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) and were guided by the PRISMA-ScR Checklist. METHODS A comprehensive and systematic search was performed in five electronic databases, namely the Scopus, Web of Sciences, CINAHL® Complete @EBSCOhost, ScienceDirect and MEDLINE. Reference lists from the screened full-text articles were reviewed. RESULTS From a total of 1252 literature screened, 22 studies published between 2010-2019 were included in the review. From those articles, four key themes were identified: (a) Prevalence of psychological distress; (b) Factors affecting family members; (c) Symptoms of psychological distress; and (d) Impact of psychological distress. CONCLUSIONS Family members with a critically ill patient in ICU show high levels of anxiety, depression and stress. They had moderate to major symptoms of psychological distress that negatively impacted both the patient and family members. RELEVANCE TO CLINICAL PRACTICE The review contributed further insights on psychological distress among ICU patient's family members and proposed psychological interventions that could positively impact the family well-being and improve the patients' recovery.
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Affiliation(s)
- Azura Abdul Halain
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.,Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Li Yoong Tang
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Noor Airini Ibrahim
- Department of Anaesthesiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing School of Medical and Life Science, Sunway University, Selangor, Malaysia
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Brei BK, Sawyer T, Umoren R, Gray MM, Krick J, Foglia EE, Ades A, Glass K, Kim JH, Singh N, Jung P, Johnston L, Moussa A, Napolitano N, Barry J, Zenge J, Quek B, DeMeo SD, Shults J, Unrau J, Nadkarni V, Nishisaki A. Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS. Arch Dis Child Fetal Neonatal Ed 2021; 106:392-397. [PMID: 33478956 PMCID: PMC8237190 DOI: 10.1136/archdischild-2020-319709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Describe the current practice of family presence during neonatal tracheal intubations (TIs) across neonatal intensive care units (NICUs) and examine the association with outcomes. DESIGN Retrospective analysis of TIs performed in NICUs participating in the National Emergency Airway Registry for Neonates (NEAR4NEOS). SETTING Thirteen academic NICUs. PATIENTS Infants undergoing TI between October 2014 and December 2017. MAIN OUTCOME MEASURES Association of family presence with TI processes and outcomes including first attempt success (primary outcome), success within two attempts, adverse TI-associated events (TIAEs) and severe oxygen desaturation ≥20% from baseline. RESULTS Of the 2570 TIs, 242 (9.4%) had family presence, which varied by site (median 3.6%, range 0%-33%; p<0.01). Family member was more often present for older infants and those with chronic respiratory failure. Fewer TIs were performed by residents when family was present (FP 10% vs no FP 18%, p=0.041). Among TIs with family presence versus without family presence, the first attempt success rate was 55% vs 49% (p=0.062), success within two attempts was 74% vs 66% (p=0.014), adverse TIAEs were 18% vs 20% (p=0.62) and severe oxygen desaturation was 49% vs 52%, (p=0.40). In multivariate analyses, there was no independent association between family presence and intubation success, adverse TIAEs or severe oxygen desaturation. CONCLUSION Family are present in less than 10% of TIs, with variation across NICUs. Even after controlling for important patient, provider and site factors, there were no significant associations between family presence and intubation success, adverse TIAEs or severe oxygen desaturation.
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Affiliation(s)
- Brianna K Brei
- Pediatrics, Division of Neonatology, University of Nebraska Medical Center, Omaha, Nebraska, USA .,Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Taylor Sawyer
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rachel Umoren
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Megan M Gray
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeanne Krick
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Elizabeth E Foglia
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne Ades
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristen Glass
- Department of Pediatrics, Division of Neonatology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jae H Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Neetu Singh
- Neonatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Philipp Jung
- Pediatrics, Universitatsklinikum Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | - Lindsay Johnston
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ahmed Moussa
- Pediatrics- Neonatology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Natalie Napolitano
- Nursing and Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James Barry
- Pediatrics, Section of Neonatology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Jeanne Zenge
- Pediatrics, Section of Neonatology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Binhuey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Stephen D DeMeo
- Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Justine Shults
- Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer Unrau
- Pediatrics, Section of Neonatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Vinay Nadkarni
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Akira Nishisaki
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Mahajan RK, Gupta S, Singh G, Mahajan R, Gautam PL. Continuous Family Access to the Intensive Care Unit: A Mixed Method Exploratory Study. Indian J Crit Care Med 2021; 25:540-550. [PMID: 34177174 PMCID: PMC8196373 DOI: 10.5005/jp-journals-10071-23805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Intensive care unit (ICU) visitation has traditionally been restrictive, primarily due to septic considerations and staff apprehension towards unrestricted visitation policy. However, ICU admission is stressful for patients and their families and the presence of family relatives at ICU patients’ bedside may help alleviate the same. The present study compares the viewpoints of healthcare workers (HCW) and patients’ family members regarding these two types of visitation policies. Materials and methods The initial assessment involved a qualitative investigation, based on an inductive grounded theory approach. Participant interviews were audiotaped, transcribed, manually coded, themes analyzed, and aggregate dimensions unfolded. Subsequently, a structured proforma filled by stakeholders and responses were coded as categorical variables (quantitative investigation). Their association with a continuous presence of family members was seen using univariate analysis (Chi-square test) and p <0.05 was considered significant. Satisfaction levels were rated on a Likert scale. Results Eighty-six stakeholders [group A: HCWs (15 doctors, 29 nurses), group B: patients (n = 18), and their relatives (n = 24)] were interviewed. While group A preferred restricted visitation policy (RVP), group B preferred unrestricted visitation policy (UVP). Quantitative data confirmed that HCWs (92.8% nurses and 85.7% doctors) were more satisfied with RVP and group B (92.3% relatives and 87.5% patients) with UVP. Group A (75.9% nurses and 93.3% doctors) therefore preferred RVP and group B (75% families and 66.6% patients) preferred UVP. Conclusion The patients and their families were more satisfied with UVP contrary to HCWs who were skeptical towards UVP and preferred RVP. How to cite this article Mahajan RK, Gupta S, Singh G, Mahajan R, Gautam PL. Continuous Family Access to the Intensive Care Unit: A Mixed Method Exploratory Study. Indian J Crit Care Med 2021;25(5):540–550.
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Affiliation(s)
- Rubina K Mahajan
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Suvidha Gupta
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramit Mahajan
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Parshotam L Gautam
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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15
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Beesley SJ, Hirshberg EL, Wilson EL, Butler JM, Oniki TA, Kuttler KG, Orme JF, Hopkins RO, Brown SM. Depression and Change in Caregiver Burden Among Family Members of Intensive Care Unit Survivors. Am J Crit Care 2020; 29:350-357. [PMID: 32869070 DOI: 10.4037/ajcc2020181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Family members of patients in intensive care units may experience psychological distress and substantial caregiver burden. OBJECTIVE To evaluate whether change in caregiver burden from intensive care unit admission to 3-month follow-up is associated with caregiver depression at 3 months. METHODS Caregiver burden was assessed at enrollment and 3 months later, and caregiver depression was assessed at 3 months. Depression was measured with the Hospital Anxiety and Depression Score. The primary analysis was the association between depression at 3 months and change in caregiver burden, controlling for a history of caregiver depression. RESULTS One hundred one participants were enrolled; 65 participants had a surviving loved one and completed 3-month follow-up. At 3-month follow-up, 12% of participants met criteria for depression. Increased caregiver burden over time was significantly associated with depression at follow-up (Fisher exact test, P = .004), although this association was not significant after controlling for self-reported history of depression at baseline (Cochran-Mantel-Haenszel test, P = .23). CONCLUSIONS Family members are increasingly recognized as a vulnerable population susceptible to negative psychological outcomes after a loved one's admission to the intensive care unit. In this small sample, no significant association was found between change in caregiver burden and depression at 3 months after controlling for baseline depression.
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Affiliation(s)
- Sarah J. Beesley
- Sarah J. Beesley is an assistant professor, Pulmonary Division and Center for Humanizing Critical Care, Intermountain Medical Center and an adjunct assistant professor, Department of Medicine, University of Utah, both in Salt Lake City, Utah
| | - Eliotte L. Hirshberg
- Eliotte L. Hirshberg is an associate professor, Pulmonary Division and Center for Humanizing Critical Care, Intermountain Medical Center; an associate professor, Department of Internal Medicine, University of Utah School of Medicine; and an adjunct associate professor, Department of Pediatrics, University of Utah, all in Salt Lake City
| | - Emily L. Wilson
- Emily L. Wilson is a statistician, Pulmonary Division and Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City
| | - Jorie M. Butler
- Jorie M. Butler is an assistant professor, Department of Internal Medicine, Division of Geriatrics, University of Utah School of Medicine and an investigator with the Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Medical Center and the Center for Humanizing Critical Care, Intermountain Medical Center, all in Salt Lake City, Utah
| | - Thomas A. Oniki
- Thomas A. Oniki and Kathryn G. Kuttler are data specialists, Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, Utah
| | - Kathryn G. Kuttler
- Thomas A. Oniki and Kathryn G. Kuttler are data specialists, Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, Utah
| | - James F. Orme
- James F. Orme is a professor, Pulmonary Division and Center for Humanizing Critical Care, Intermountain Medical Center and a professor, Department of Medicine, University of Utah, both in Salt Lake City
| | - Ramona O. Hopkins
- Ramona O. Hopkins is a professor, Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah and the Pulmonary Division and Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, Utah
| | - Samuel M. Brown
- Samuel M. Brown is an associate professor, Pulmonary Division and Center for Humanizing Critical Care, Intermountain Medical Center and an associate professor, Department of Medicine, University of Utah, Salt Lake City
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17
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Goldfarb M, Bibas L, Burns K. Patient and Family Engagement in Care in the Cardiac Intensive Care Unit. Can J Cardiol 2020; 36:1032-1040. [PMID: 32533931 DOI: 10.1016/j.cjca.2020.03.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/26/2022] Open
Abstract
Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one's illness, powerless to affect their care, and struggle to comprehend information regarding their loved one's current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative's care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.
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Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Lior Bibas
- Division of Cardiology, Pierre-Boucher Hospital, Longueuil, Quebec, Canada
| | - Karen Burns
- Division of Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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19
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Niemczyk E, Ozga D, Przybylski A. Experiences and Opinions of Patients and Their Relatives to Family Presence During Adult Resuscitation in Poland: Quantitative Research. Patient Prefer Adherence 2020; 14:227-234. [PMID: 32103907 PMCID: PMC7023900 DOI: 10.2147/ppa.s229618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/06/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Scientific research and public opinion polls indicate that the majority of patients and their families believe that members of the patients' family should be offered the opportunity to be present during CPR, at the moment of their loved one's death, and throughout all aspects of emergency care. The study was designed to analyse the experiences and opinions of patients and family members towards Family Presence During Resuscitation (FPDR) in hospitals in Poland. PATIENTS AND METHODS We conducted a survey related to FPDR among patients and their families during 5 months in 2017. That was preceded by a pilot study. We asked the patients and the people accompanying them to complete the questionnaire during admission to the hospital; 1000 questionnaires (500 patient responses and 500 family responses) were included in the analysis. RESULTS Patients and their relatives more often wanted to be present during resuscitation of a loved one than they agreed to the presence of the family during their resuscitation. The vast majority of patients did not know the patient's rights regarding FPDR. 24.2% of patients and 29.2% of their relatives participated in the discussions on FPDR. The interest in FPDR indicated 29.0% of patients and 27.6% of family members. CONCLUSION In our survey study, both patients and their family members had a negative attitude towards FPDR. Respondents (both patients and family members) had a low level of awareness that their potential to be present during CPR was included in the patient's rights.
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Affiliation(s)
- Edyta Niemczyk
- Institute of Health Sciences, Collegium Medicum, The University of Rzeszow, Rzeszow35-310, Poland
| | - Dorota Ozga
- Institute of Health Sciences, Collegium Medicum, The University of Rzeszow, Rzeszow35-310, Poland
- Correspondence: Dorota Ozga Tel +48 178571955 Email
| | - Andrzej Przybylski
- Institute of Medical Sciences, Collegium Medicum, University of Rzeszow, Rzeszow35-310, Poland
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21
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Brown SM, Azoulay E, Benoit D, Butler TP, Folcarelli P, Geller G, Rozenblum R, Sands K, Sokol-Hessner L, Talmor D, Turner K, Howell MD. The Practice of Respect in the ICU. Am J Respir Crit Care Med 2019; 197:1389-1395. [PMID: 29356557 DOI: 10.1164/rccm.201708-1676cp] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.
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Affiliation(s)
- Samuel M Brown
- 1 Center for Humanizing Critical Care, Intermountain Medical Center, Murray, Utah.,2 Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Elie Azoulay
- 3 Medical School, Paris Diderot University, Sorbonne Paris-Cité, Paris, France
| | - Dominique Benoit
- 4 Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.,5 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | | | - Gail Geller
- 8 Berman Institute of Bioethics and.,9 School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ronen Rozenblum
- 10 Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ken Sands
- 11 Clinical Services Group, Hospital Corporation of America, Nashville, Tennessee
| | | | - Daniel Talmor
- 12 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kathleen Turner
- 13 Department of Nursing, University of California San Francisco Medical Center, San Francisco, California; and
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Abstract
BACKGROUND The practice of electroconvulsive therapy (ECT) is often hampered by stigma and myths prevailing among patients and families. Family attendance at ECT has not been systematically studied. METHODS From January 2017 to May 2018, 69 consecutive patients were approached for family attendance at ECT. The inclusion criteria for entry to the ECT suite were consent from families and patients, age older than 18 years, and 1 family member at a time. After watching ECT, family members completed a multiple-choice questionnaire regarding their experience. RESULTS Twenty-one family members watched ECT. A majority viewed the idea of attendance at ECT as reassuring, and a few indicated that it was anxiety provoking. Five participants (24%) felt distressed while watching the procedure, whereas 16 family members rated their experience as comfortable or rewarding (76%). In terms of the outcome, a clear majority have responded that watching the procedure alleviated their fears of ECT or provided transformative knowledge, whereas others felt no change in their attitude toward ECT (71% vs 29%). Most of the participants recommended watching ECT to other family members, whereas a minority was uncertain about their opinion (62% vs 38%). There were no adverse effects, premature exit from the ECT suite, interferences with treatment, or litigations. CONCLUSIONS A clear majority of families viewed their attendance at ECT as a beneficial experience. Family presence during ECT may have the potential to promulgate its practice by reducing stigma and misconceptions.
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Affiliation(s)
| | - Angela Ang
- Peter James Centre, Eastern Health, Victoria, Australia
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Comparison the effect of trained and untrained family presence on their anxiety during invasive procedures in an emergency department: A randomized controlled trial. Turk J Emerg Med 2019; 19:100-105. [PMID: 31321342 PMCID: PMC6612628 DOI: 10.1016/j.tjem.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The present study was aimed to compare the effect of the trained and untrained family presence on their anxiety during invasive procedures in an emergency department. Methods In this randomized controlled clinical trial, 90 patients who were candidates for receiving invasive nursing procedures were selected in an emergency department based on the inclusion criteria, and then were equally assigned into 3 groups by the random minimization method: A ("presence of the trained family member group "), B ("presence of the untrained family member group "), and C ("absence and untrained family member group"). The anxiety level was measured before and after implementation of the procedure using the Spielberger State-Trait Anxiety Inventory (STAI). The data were analyzed by SPSS software using the Kolmogorov-Smirnov test, Chi-Square test, Kruskal Wallis Independent-Samples test, Paired Samples T-test, and ANOVA at the significance level of 0.05. Results The three groups were similar in terms of demographic variables. In all three groups, the SATI score significantly decreased after intervention phase (p = 0.001). The mean changes of the SATI score were not statistically different between the groups. However, The STAI score decreased significantly after intervention in the group B compared to the group A (p = 0.011) and C (p = 0.042). However, there was no significant difference between the SATI score in the group A and C (p = 0.867). Conclusion The results of the study revealed that, the “presence of the untrained" family members caused them to experience significantly less anxiety than the other two groups. However, changes in the anxiety score were not significant between the groups.
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Family presence during resuscitation: A narrative review of the practices and views of critical care nurses. Intensive Crit Care Nurs 2019; 53:15-22. [PMID: 31053336 DOI: 10.1016/j.iccn.2019.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The option of family presence during resuscitation was first presented in the late 1980s. Discussion and debate about the pros and cons of this practice has led to an abundant body of international research. AIM To determine critical care nurses' experiences of, and support for family presence during adult and paediatric resuscitation and their views on the positive and negative effects of this practice. METHODS A narrative literature review of primary research published 2005 onwards. The search strategy comprised an electronic search of three bibliographic databases, supplemented by exploration of a web-based search engine and hand-searching. RESULTS Twelve studies formed the review. Research primarily originated from Europe. The findings were obtained from a moderately small number of nurses, and their views were mostly based on conjecture. Among the factors influencing family presence during resuscitation were dominant concerns about harmful effects. There was a noticeable absence of compliance with recommended guidelines for practice, and the provision of a unit protocol or policy to assist decision-making. CONCLUSION A commitment to family-centred care, educational intervention and the uptake of professional guidance are recommended evidence-informed strategies to enhance nurses' support for this practice in critical care.
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Yakubu YH, Esmaeili M, Navab E. Family members' beliefs and attitudes towards visiting policy in the intensive care units of Ghana. Nurs Open 2019; 6:526-534. [PMID: 30918703 PMCID: PMC6419108 DOI: 10.1002/nop2.234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/15/2018] [Accepted: 11/23/2018] [Indexed: 12/04/2022] Open
Abstract
AIM This study aimed to investigate family members' beliefs and attitudes towards the visiting policies of intensive care units (ICUs). DESIGN It employed a descriptive cross-sectional quantitative design. METHOD This study recruited four public hospitals in Ghana with a sample of 200 family members. The study was conducted using a self-administered questionnaire. The data were collected and analysed with SPSS version 16. RESULTS This study revealed that while family members believed in the beneficial effect of adhering to open visiting policies in ICUs, their attitudes were sceptical and restrictive. Most family members preferred the acceptable number of visitors within 24 hr to be two, and according to them, only one person should be allowed to enter at a time. There was a meaningful relationship between the families' beliefs and religion (p = 0.02), educational level (p = 0.03) and family status (p = 0.02). Furthermore, a meaningful relationship was also observed between the families' attitudes and status (p = 0.04) and their level of education (p = 0.05). The studied family members showed concern in this regard and did not want the community style of visiting to be implemented, which could hinder patients' recovery.
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Affiliation(s)
- Yakubu H. Yakubu
- Intensive Care Nursing, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Maryam Esmaeili
- Nursing and Midwifery Care Research CenterTehran University of Medical SciencesTehranIran
- Department of Critical Care Nursing, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Elham Navab
- Department of Critical Care Nursing, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
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How Nurse Work Environments Relate to the Presence of Parents in Neonatal Intensive Care. Adv Neonatal Care 2019; 19:65-72. [PMID: 28953056 DOI: 10.1097/anc.0000000000000431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parental presence in the neonatal intensive care unit (NICU) is essential for families to participate in infant care and prepare them to transition from hospital to home. Nurses are the principal caregivers in the NICU. The nurse work environment may influence whether parents spend time with their hospitalized infants. PURPOSE To examine the relationship between the NICU work environment and parental presence in the NICU using a national data set. METHODS We conducted a cross-sectional, observational study of a national sample of 104 NICUs, where 6060 nurses reported on 15,233 infants cared for. Secondary analysis was used to examine associations between the Practice Environment Scale of the Nursing Work Index (PES-NWI) (subscale items and with a composite measure) and the proportion of parents who were present during the nurses' shift. RESULTS Parents of 60% (SD = 9.7%) of infants were present during the nurses' shift. The PES-NWI composite score and 2 domains-Nurse Participation in Hospital Affairs and Manager Leadership and Support-were significant predictors of parental presence. A 1 SD higher score in the composite or either subscale was associated with 2.5% more parents being present. IMPLICATIONS FOR PRACTICE Parental presence in the NICU is significantly associated with better nurse work environments. NICU practices may be enhanced through enhanced leadership and professional opportunities for nurse managers and staff. IMPLICATIONS FOR RESEARCH Future work may benefit from qualitative work with parents to illuminate their experiences with nursing leaders and nurse-led interventions in the NICU and design and testing of interventions to improve the NICU work environment.
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Bensouda B, Mandel R, Mejri A, Lachapelle J, St-Hilaire M, Ali N. Effect of an audience on trainee stress and performance during simulated neonatal intubation: a randomized crossover trial. BMC MEDICAL EDUCATION 2018; 18:230. [PMID: 30285715 PMCID: PMC6171149 DOI: 10.1186/s12909-018-1338-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Neonatal intubation is a stressful procedure taught to trainees. This procedure can attract additional observers. The impact of observers on neonatal intubation performance by trainees has not been studied. Our objective was to evaluate if additional observers present during neonatal mannequin endotracheal intubation (NMEI) by junior trainees, affects their performance and their stress levels. METHODS A randomized cross over trial was conducted. First year residents with no experience in neonatal intubation were assigned to NMEI condition A or B randomly on day 1. Subjects were crossed over to the other condition on day 2. Condition A: Only one audience member was present Condition B: Presence of an audience of 5 health care providers. Differences in the time to successful NMEI was recorded and compared between conditions. A portable heart rate monitor was used to measure peak heart rate above baseline during NMEI under both conditions. RESULTS Forty nine residents were recruited. 72% were female with a median age of 25 years (IQR: 24-27). Time to successful intubation was comparable under both conditions with a mean difference of - 3.94 s (95% CI: -8.2,0.4). Peak heart rate was significantly lower under condition A (mean difference - 11.9 beats/min, 95% CI -15.98 to - 7.78). CONCLUSION Although the time required to NMEI did not increase, our results suggest that presence of observers significantly increases trainee stress. The addition of extraneous observers during simulation training may better equip residents to deal with such stressors. TRIAL REGISTRATION Date of registration: March 2016, NCT 02726724 .
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Affiliation(s)
- Brahim Bensouda
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Romain Mandel
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Abdelwaheb Mejri
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Jean Lachapelle
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Marie St-Hilaire
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Nabeel Ali
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
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Haines KJ. Engaging Families in Rehabilitation of People Who Are Critically Ill: An Underutilized Resource. Phys Ther 2018; 98:737-744. [PMID: 30113660 DOI: 10.1093/ptj/pzy066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 08/01/2018] [Indexed: 11/12/2022]
Abstract
Rehabilitation of people who are critically ill has received increased attention in recent years, although this has not extended to specifically facilitating family involvement. Engaging families in the rehabilitation arc has the potential to optimize outcomes. Likely benefits include redirecting family psychological distress into an active participatory role, humanizing the patient illness and recovery experience, and supporting staff and the health care system beyond the constraints of therapy time. This viewpoint explores why families should be engaged in critical care rehabilitation, gives an overview of the evidence for family participation in bedside care, and provides practical implementation strategies and signpost areas for future research.
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Affiliation(s)
- Kimberley J Haines
- Physiotherapy Department, Western Health, Furlong Road, St Albans, Victoria 3021, Australia; and Australia and New Zealand Research Centre, Monash University, 553 St Kilda Rd, VIC 3004, Australia
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In W, Kim YM, Kim HS, Hong S, Suh Y, Cha Y, Kim N, Kim J, Kang H, Kwon H, Kim Y, Park W. The Effect of a Parental Visitation Program on Emergence Delirium Among Postoperative Children in the PACU. J Perianesth Nurs 2018; 34:108-116. [PMID: 30005899 DOI: 10.1016/j.jopan.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/31/2018] [Accepted: 04/07/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to examine the effects of parental presence on the incidence of emergence delirium (ED) of children in the postanesthesia care unit (PACU). DESIGN A quasi-experimental pretest and post-test study with nonequivalent and nonsynchronized control groups. METHODS About 93 children aged 3 to 6 years undergoing general anesthesia for tonsillectomy were divided into two groups: parental presence and absence. ED was recorded using the Pediatric Anesthesia Emergence Delirium Scale at 0, 10, 20, and 30 minutes after PACU admission. FINDINGS ED score at each time point in the experimental group was lower than the control group, but not statistically significant. ED score in the experimental group significantly decreased over time (F = 6.98; P = .010). CONCLUSIONS Parental visitation programs could be effective on the degree of ED in children in the PACU setting. This result may contribute to the establishment of PACU visitation program policy in South Korea.
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Brown SM, Talmor D, Howell MD. Building communities of respect in the intensive care unit. Intensive Care Med 2018; 44:1339-1341. [PMID: 29961105 DOI: 10.1007/s00134-018-5259-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Samuel M Brown
- Center for Humanizing Critical Care, Intermountain Medical Center and Department of Internal Medicine, University of Utah School of Medicine, Murray, UT, USA.
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Twibell R, Siela D, Riwitis C, Neal A, Waters N. A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation. J Clin Nurs 2017; 27:e320-e334. [PMID: 28677220 DOI: 10.1111/jocn.13948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
Abstract
AIMS AND OBJECTIVES To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation. BACKGROUND Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations. Research has not clarified the factors that influence the decision-making processes of nurses and physicians related to inviting family presence. This is the first study to elicit written data from healthcare professionals to explicate factors in decision-making about family presence. DESIGN Qualitative exploratory-descriptive. METHODS Convenience samples of registered nurses (n = 325) and acute care physicians (n = 193) from a Midwestern hospital in the United States of America handwrote responses to open-ended questions about family presence. Through thematic analysis, decision-making factors for physicians and nurses were identified and compared. RESULTS Physicians and nurses evaluated three similar factors and four differing factors when deciding to invite family presence during resuscitation. Furthermore, nurses and physicians weighted the factors differently. Physicians weighted most heavily the family's potential to disrupt life-saving efforts and compromise patient care and then the family's knowledge about resuscitations. Nurses heavily weighted the potential for the family to be traumatised, the potential for the family to disrupt the resuscitation, and possible family benefit. CONCLUSIONS Nurses and physicians considered both similar and different factors when deciding to invite family presence. Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team. RELEVANCE TO CLINICAL PRACTICE Knowledge of factors that influence the decision-making of interprofessional colleagues can improve collaboration and communication in crisis events of family presence during resuscitation.
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Affiliation(s)
- Renee Twibell
- School of Nursing, Ball State University, Muncie, IN, USA.,Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
| | - Debra Siela
- School of Nursing, Ball State University, Muncie, IN, USA
| | - Cheryl Riwitis
- Indiana University Health LifeLine, Indianapolis, IN, USA
| | - Alexis Neal
- Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
| | - Nicole Waters
- Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
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Acute psychological trauma in the critically ill: Patient and family perspectives. Gen Hosp Psychiatry 2017; 47:68-74. [PMID: 28807140 DOI: 10.1016/j.genhosppsych.2017.04.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Post-intensive care syndrome (PICS), which encompasses profound psychological morbidity, affects many survivors of critical illness. We hypothesize that acute psychological stress during the intensive care unit (ICU) confinement likely contributes to PICS. In order to develop strategies that mitigate PICS associated psychological morbidity, it is paramount to first characterize acute ICU psychological stress and begin to understand its causative and protective factors. METHODS A structured interview study was administered to adult critical illness survivors who received ≥48h of mechanical ventilation in medical and surgical ICUs of a tertiary care center, and their families. RESULTS Fifty patients and 44 family members were interviewed following ICU discharge. Patients reported a high level of psychological distress. The families' perception of patient's stress level correlated with the patient's self-estimated stress level both in daily life (rho=0.59; p<0.0001) and in ICU (rho=0.45; p=0.002). 70% of patients experienced fear of death, 38% had additional other fears, 48% had hallucinations. Concerns included inability to communicate (34%), environmental factors (30%), procedures and restraints (24%), and being intubated (12%). Emotional support of family/friend/staff/clergy (86%), and physical therapy/walking (14%) were perceived to be important mitigating factors. Clinicians' actions that were perceived to be very constructive included reassurance (54%), explanations (32%) and physical touch (8%). CONCLUSIONS Fear, hallucinations, and the inability to communicate, are identified as central contributors to psychological stress during an ICU stay; the presence of family, and physician's attention are categorized as important mitigating factors. Patients and families identified several practical recommendations which may help assuage the psychological burden of the ICU stay.
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