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Docherty C, Quasim T, MacTavish P, Devine H, O'Brien P, Strachan L, Lucie P, Hogg L, Shaw M, McPeake J. Anxiety and depression following critical illness: A comparison of the recovery trajectories of patients and caregivers. Aust Crit Care 2024:S1036-7314(24)00084-5. [PMID: 38797584 DOI: 10.1016/j.aucc.2024.04.005] [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: 11/08/2023] [Revised: 03/01/2024] [Accepted: 04/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Following critical illness, family members are often required to adopt caregiving responsibilities. Anxiety and depression are common long term problems for both patients and caregivers. However, at present, it is not known how the trajectories of these symptoms compare between patients and caregivers. OBJECTIVES The aim of this study was to investigate and compare the trajectories of anxiety and depression in patients and caregivers in the first year following critical illness. METHODS This study analyses data from a prospective multicentre cohort study of patients and caregivers who underwent a complex recovery intervention following critical illness. Paired patients and caregivers were recruited. The Hospital Anxiety and Depression Scale was used to evaluate symptoms of anxiety and depression at three timepoints: baseline; 3 months; and 12 months in both patient and caregivers. A linear mixed-effects regression model was used to evaluate the trajectories of these symptoms over the first year following critical illness. RESULTS 115 paired patients and caregivers, who received the complex recovery intervention, were recruited. There was no significant difference in the relative trajectory of depressive symptoms between patients and caregivers in the first 12 months following critical illness (p = 0.08). There was, however, a significant difference in the trajectory of anxiety symptoms between patients and caregivers during this time period (p = 0.04), with caregivers seeing reduced resolution of symptoms in comparison to patients. CONCLUSIONS Following critical illness, symptoms of anxiety and depression are common in both patients and caregivers. The trajectory of symptoms of depression was similar between caregivers and patients; however, there was a significantly different recovery trajectory in symptoms of anxiety. Further research is required to understand the recovery pathway of caregivers in order to design effective interventions.
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Affiliation(s)
- Christie Docherty
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Tara Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Helen Devine
- Intensive Care Unit, University Hospital Crosshouse, Kilmarnock, UK
| | - Peter O'Brien
- Intensive Care Unit, University Hospital Crosshouse, Kilmarnock, UK
| | - Laura Strachan
- Intensive Care Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Phil Lucie
- Intensive Care Unit, University Hospital Wishaw, North Lanarkshire, UK
| | - Lucy Hogg
- Intensive Care Unit, Victoria Hospital, Kirkcaldy, UK
| | - Martin Shaw
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK.
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Tejero-Aranguren J, García Del Moral R, Poyatos-Aguilera ME, Colmenero M. Family burden after critical illness: the forgotten caregivers. Med Intensiva 2024; 48:69-76. [PMID: 37783615 DOI: 10.1016/j.medine.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To determine the incidence of primary caregiver burden in a cohort of family members of critically ill patients admitted to ICU and to identify risk factors related to its development in both the patient and the family member. DESIGN Prospective observational cohort study was conducted for 24 months. SETTING Hospital Universitario Clínico San Cecilio, Granada. PATIENTS The sample was the primary caregivers of all patients with risk factors for development of PICS (Post-Intensive Care Syndrome). INTERVENTIONS The follow-up protocol consisted of evaluation 3 months after discharge from the ICU in a specific consultation. MAIN VARIABLES OF INTEREST The scales used in patients were Barthel, SF-12, HADS, Pfeiffer, IES-6 and in relatives the Apgar and Zarit. RESULTS A total of 93 patients and caregivers were included in the follow-up. 15 relatives did not complete the follow-up questionnaires and were excluded from the study. The incidence of PICS-F (Family Post Intensive Care Syndrome) defined by the presence of primary caregiver burden in our cohort of patients is 34.6% (n=27), 95% CI 25.0-45.7. The risk factors for the development of caregiver burden are the presence of physical impairment, anxiety or post-traumatic stress in the patient, with no relationship found with the characteristics studied in the family member. CONCLUSIONS One out of 3 relatives of patients with risk factors for the development of PICS presents at 3 months caregiver burden. This is related to factors dependent on the patient's state of health.
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Affiliation(s)
| | - Raimundo García Del Moral
- POD Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain; Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | - Manuel Colmenero
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Ibs. Granada, Spain
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Kreitzer N, Adeoye O, Wade SL, Kurowki BG, Thomas S, Gillespie L, Bakas T. Iterative Development of the Caregiver Wellness After Traumatic Brain Injury Program (CG-Well). J Head Trauma Rehabil 2023; 38:E424-E436. [PMID: 36951450 PMCID: PMC10517076 DOI: 10.1097/htr.0000000000000869] [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: 03/24/2023]
Abstract
OBJECTIVES (1) To iteratively design a web/phone-based intervention to support caregivers of adults acutely following traumatic brain injury (TBI), Caregiver Wellness (CG-Well), and (2) to obtain qualitative and quantitative feedback on CG-Well from experts and caregivers to refine the intervention. SETTING A level I trauma and tertiary medical center. PARTICIPANTS Convenience sample of a total of 19 caregivers and 25 experts. DESIGN Multistep prospective study with iterative changes to CG-Well: (1) developed intervention content based on qualitative feedback from a prior study and literature review; (2) obtained qualitative feedback from 10 experts; (3) refined content using a modified Delphi approach involving 4 caregivers and 6 experts followed by qualitative interviews with 9 caregivers; (4) designed CG-Well website and videos; and (5) obtained feedback on program acceptability, appropriateness, and feasibility from 6 caregivers and 9 experts. INTERVENTIONS CG-Well included content on TBI, self-care and support, and skill-building strategies delivered through a website and telephone calls. MAIN OUTCOME MEASURES Qualitative data were analyzed using content analysis. Caregivers and experts completed Likert-type scales to rate module relevance, clarity, accuracy, utility and website acceptability, appropriateness, and feasibility (1 = strongly disagree to 5 = strongly agree). Means and standard deviations (SD) characterized ratings. RESULTS Qualitative findings were instrumental in designing and refining CG-Well. Ratings were positive for modules (means and SD for relevant [4.9, 0.33], clear [4.6, 0.53], accurate [4.9, 0.33], and useful [5, 0]) and the website (means and SD for acceptable [4.8, 0.36], appropriate [4.8, 0.35], and feasible [4.8, 0.36]). CONCLUSIONS The iterative design process for CG-Well resulted in a highly acceptable program. An early-stage randomized controlled trial is underway to estimate treatment effects for a future well-powered clinical trial.
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Affiliation(s)
- Natalie Kreitzer
- Department of Emergency Medicine (Drs Kreitzer and Gillespie and Ms Thomas) and College of Nursing (Dr Bakas), University of Cincinnati, Cincinnati, Ohio; Department of Emergency Medicine, Washington University, St Louis, Missouri (Dr Adeoye); Departments of Pediatrics (Dr Wade) and Pediatrics and Neurology and Rehabilitation Medicine (Dr Kurowki), Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Kurowki)
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4
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Doherty C, Feder S, Gillespie-Heyman S, Akgün KM. Easing Suffering for ICU Patients and Their Families: Evidence and Opportunities for Primary and Specialty Palliative Care in the ICU. J Intensive Care Med 2023:8850666231204305. [PMID: 37822226 DOI: 10.1177/08850666231204305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Intensive care unit (ICU) admissions are often accompanied by many physical and existential pressure points that can be extraordinarily wearing on patients and their families and surrogate decision makers (SDMs). Multidisciplinary palliative support, including physicians, advanced practice nurses, nutritionists, chaplains and other team members, may alleviate many of these sources of potential suffering. However, the palliative needs of ICU patients undoubtedly exceed the bandwidth of current consultative specialty palliative medicine teams. Informed by standard-of-care palliative medicine domains, we review common ICU symptoms (pain, dyspnea and thirst) and their prevalence, sources and their treatment. We then identify palliative needs and impacts in the domains of communication, SDM support and transitions of care for patients and their families through their journey in the ICU, from discharge and recovery at home to chronic critical illness, post-ICU disability or death. Finally, we examine the evidence for strategies to incorporate specialty palliative medicine and palliative principles into ICU care for the improvement of patient- and family-centered care. While randomized controlled studies have failed to demonstrate measurable improvement in pre-determined outcomes for patient- and family-relevant outcomes, embracing the principles of palliative medicine and assuring their delivery in the ICU is likely to translate to overall improvement in humanistic, person-centered care that supports patients and their SDMs during and following critical illness.
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Affiliation(s)
- Christine Doherty
- Department of Internal Medicine New Haven, Yale New Haven Hospital, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Shelli Feder
- Yale University School of Nursing, Orange, CT, USA
| | | | - Kathleen M Akgün
- Yale School of Medicine, New Haven, CT, USA
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, VA-Connecticut and Yale University School of Medicine, New Haven, CT, USA
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5
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Best A, Harvey C, Minton C. Experiences of families of prolonged critical illness survivors that are discharged home: An integrative review of the literature. Nurs Crit Care 2023. [DOI: 10.1111/nicc.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Amy Best
- School of Nursing Massey University Wellington New Zealand
- Intensive Care Unit Wellington Regional Hospital Wellington New Zealand
| | - Clare Harvey
- School of Nursing Massey University Wellington New Zealand
| | - Claire Minton
- School of Nursing Massey University Palmerston North New Zealand
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6
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Edwell A, Schaik SV, Desai M. Beyond satisfaction: evaluating understanding in PICU family centered rounds. JOURNAL OF COMMUNICATION IN HEALTHCARE 2022; 15:267-275. [PMID: 36911895 DOI: 10.1080/17538068.2021.1996817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many hospitals have adopted Family Centered Rounds (FCR), as a means to optimize communication. While studies show FCR improves family satisfaction, research on the impact on family understanding of their child's care has been conflicting. Understanding is particularly important when families are asked to share in complex decision making, as occurs in the Pediatric Intensive Care Unit (PICU). This study explores families' experiences of FCR in the PICU and examines how FCR impacts their understanding of their child's care. METHODS We conducted surveys and interviews of family members after they attended FCR in two PICUs. The survey assessed families' satisfaction with rounds and their understanding across three domains: the child's illness, treatments, and prognosis. Physicians completed a similar survey to examine concordance with families' understanding. In interviews we explored underlying factors. We identified themes from transcripts through thematic analysis. RESULTS Twenty-five family members completed the survey and participated in interviews. The majority (82%) rated their satisfaction with FCR highly. Discordance between families and physicians in understanding was common, especially in the prognosis domain, with concordance rates as low as 27%. We identified four themes from interviews that shed light on families' experiences and the relationship between FCR and understanding: Jargon, Feeling Part of the Team, Rounds as Overwhelming and Competing Purposes of Rounds. CONCLUSION Families in our study had similar satisfaction with FCR as previously reported, yet our findings suggest that FCR can be optimized to achieve family understanding. Our findings provide insights into potential ways to accomplish this.
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Affiliation(s)
- April Edwell
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | | | - Mansi Desai
- Department of Pediatrics, University of California, San Francisco, CA, USA
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7
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McPeake J, Henderson P, MacTavish P, Devine H, Daniel M, Lucie P, Bollan L, Hogg L, MacMahon M, Mulhern S, Murray P, O'Neill L, Strachan L, Iwashyna TJ, Shaw M, Quasim T. A multicentre evaluation exploring the impact of an integrated health and social care intervention for the caregivers of ICU survivors. Crit Care 2022; 26:152. [PMID: 35610616 PMCID: PMC9128318 DOI: 10.1186/s13054-022-04014-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Caregivers and family members of Intensive Care Unit (ICU) survivors can face emotional problems following patient discharge from hospital. We aimed to evaluate the impact of a multi-centre integrated health and social care intervention, on caregiver and family member outcomes.
Methods This study evaluated the impact of the Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme across 9 sites in Scotland. InS:PIRE is an integrated health and social care intervention. We compared caregivers who attended this programme with a contemporary control group of ICU caregivers (usual care cohort), who did not attend. Results The primary outcome was anxiety measured via the Hospital Anxiety and Depression Scale at 12 months post-hospital discharge. Secondary outcome measures included depression, carer strain and clinical insomnia. A total of 170 caregivers had data available at 12 months for inclusion in this study; 81 caregivers attended the InS:PIRE intervention and completed outcome measures at 12 months post-hospital discharge. In the usual care cohort of caregivers, 89 completed measures. The two cohorts had similar baseline demographics. After adjustment, those caregivers who attended InS:PIRE demonstrated a significant improvement in symptoms of anxiety (OR: 0.42, 95% CI: 0.20–0.89, p = 0.02), carer strain (OR: 0.39; 95% CI: 0.16–0.98 p = 0.04) and clinical insomnia (OR: 0.40; 95% CI: 0.17–0.77 p < 0.001). There was no significant difference in symptoms of depression at 12 months.
Conclusions This multicentre evaluation has shown that caregivers who attended an integrated health and social care intervention reported improved emotional health and less symptoms of insomnia, 12 months after the delivery of the intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04014-z.
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Affiliation(s)
- Joanne McPeake
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK. .,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Philip Henderson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Helen Devine
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Malcolm Daniel
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Phil Lucie
- Intensive Care Unit, University Hospital Wishaw, Wishaw, UK
| | - Lynn Bollan
- Intensive Care Unit, University Hospital Wishaw, Wishaw, UK
| | - Lucy Hogg
- Intensive Care Unit, NHS Fife, Kirkcaldy, UK
| | | | - Sharon Mulhern
- Intensive Care Unit, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Pauline Murray
- Intensive Care Unit, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Laura O'Neill
- Intensive Care Unit, University Hospital Monklands, Airdrie, UK
| | - Laura Strachan
- Intensive Care Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Theodore J Iwashyna
- Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, USA.,Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Martin Shaw
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.,Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tara Quasim
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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8
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Hansda U, Tripathy S, Sahoo AK, Panda I, Shetty AP, Mitra JK, Sanyal K, Venkateshan M, Paniyadi NK, Rao PB, Mahapatra S. Home Care of Tracheostomized Chronically Critically Ill Patients: A Study of Caregivers’ Burden and Comparison with the Burden of Palliative Care Patients in India. Indian J Crit Care Med 2022; 26:579-583. [PMID: 35719438 PMCID: PMC9160625 DOI: 10.5005/jp-journals-10071-24151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Chronically critically ill (CCI) patients often have high costs of care and poor outcomes. Disease management programs offering home care may reduce costs but need buy-in from informal caregivers. An understanding of caregiver burden in this population is lacking. We aimed to study the caregiver burden, its change over time, and factors affecting it, in post-ICU tracheostomized patients. We compared the caregiver burden among CCI carers to that of palliative caregivers. Materials and methods Informal caregivers of thirty chronically critically ill tracheostomized patients (CGcci) were administered the Caregivers Burden Scale (CBS) tool at discharge, 2 and 4 weeks after discharge. A one-point assessment of burden was made in 30 caregivers of patients enrolled in Pain and Palliative care clinic (CGpc). Linear mixed models for repeated measures were used to analyze score of CGcci over time and compared to the burden in physical, psychologic, economic, time, and social domains between groups. Results All 60 caregivers were young (33–35 years), predominantly male, and children of the patients. Both CGcci and CGpc had moderate burden score of 60.5 (14.7) vs 61.5 (13), respectively. Physical burden (11.5 vs 8) was greater in CGcci (p = 0.001) compared to psychologic domain (10 vs 12.5) in CGpc (p = 0.01). Burden score over all domains in CGcci decreased rapidly from 67.5 (8) to 55 (16.5) (p = 0.001) in the first month after discharge. Conclusion Burden of care among caregivers of tracheostomized chronically critically ill patients is comparable to those of palliative caregivers and reduces significantly with time. CTRI 2020/11/029443 (registered on: 27/11/2020) How to cite this article Hansda U, Tripathy S, Sahoo AK, Panda I, Shetty AP, Mitra JK, et al. Home Care of Tracheostomized Chronically Critically Ill Patients: A Study of Caregivers’ Burden and Comparison with the Burden of Palliative Care Patients in India. Indian J Crit Care Med 2022;26(5):579–583.
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Affiliation(s)
- Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
- Upendra Hansda, Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, Phone: +91 6742476400, e-mail:
| | - Swagata Tripathy
- Department of Anesthesia and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Alok Kumar Sahoo
- Department of Anesthesia and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Itimayee Panda
- Department of Anaesthesiology, Bhubaneswar, Odisha, India
| | - Asha P Shetty
- Department of Child Health Nursing, College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jayanta Kumar Mitra
- Department of Anesthesia and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kasturi Sanyal
- Department of Anaesthesiology, Bhubaneswar, Odisha, India
| | - Mahalingam Venkateshan
- Department of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nanda Kumar Paniyadi
- Department of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Parnandi Bhaskar Rao
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sujata Mahapatra
- Department of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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9
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Hetland BD, McAndrew NS, Kupzyk KA, Krutsinger DC, Pozehl BJ, Heusinkvelt JM, Camenzind CE. Family Caregiver Preferences and Contributions Related to Patient Care in the ICU. West J Nurs Res 2021; 44:214-226. [PMID: 34904483 DOI: 10.1177/01939459211062954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Guided by Individual and Family Self-Management Theory, the purpose of this cross-sectional study was to describe patient care activities that family caregivers endorsed and performed while visiting their family member in the ICU. We found that caregivers wanted to be involved in ICU patient care and had preferences for the care they wanted to perform with their critically ill family member. More than 80% preferred to perform tasks related to daily grooming, communication, and education. Of note, many caregivers expressed interest in holistic healing activities (i.e., music and art), and yet, less than 50% of caregivers reported participating in these activities. The discrepancy between the number of care activities that respondents desired to perform compared to the number of care activities they reported performing represents an important opportunity to shift research and practice improvement efforts toward more tailored family engagement interventions and recognition of family caregivers as essential partners in care.
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Affiliation(s)
- Breanna D Hetland
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA.,Critical Care Division, Nebraska Medicine, Omaha, NE, USA
| | - Natalie S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.,Froedtert Hospital, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dustin C Krutsinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bunny J Pozehl
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
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10
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Charos D, Merluzzi TV, Kolokotroni P, Lykeridou K, Deltsidou A, Vivilaki V. Breast cancer and social relationship coping efficacy: validation of the Greek version. Women Health 2021; 61:947-956. [PMID: 34706626 DOI: 10.1080/03630242.2021.1994101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Social Relationship Coping Efficacy scale (SRCE) was designed to assess cancer patients' efficacy for maintaining social support and social relationships. The purpose of the study was to confirm the psychometric quality and utility of a Greek-language version of the (SRCE) scale. The study included 116 women with breast cancer, who underwent surgery at a public hospital In Greece. The SRCE scale was translated using standard procedures and then culturally adapted for use in Greece. Psychometric evaluation of the SRCE-Greek scale included reliability, structural validity and convergent validity analyses. The SRCE-Greek scale demonstrated strong internal consistency (Cronbach a 0.87), and split-half reliability (Spearman-Brown, 0.747; Guttman, 0.742). The structural construct validity was confirmed with factor analysis using principal axis factor analysis. Construct validity was further supported with convergent validity with the Family Crisis Oriented Personal Evaluation Scales (F-COPES) (Acquiring Social Support, Reframing) and Family Support scale. The Greek language SRCE has strong internal consistency reliability and construct validity, as well as satisfactory convergent validity. Results provide support for the use of the SRCE-GR as a research and clinical instrument for the assessment of breast cancer patient's self-efficacy with regard to maintaining and enhancing close social relationships and social support.
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Affiliation(s)
- Dimitrios Charos
- Midwifery Department, University of West Attica, Athens, Greece.,Psychologist, General Anti-Cancer Hospital Agios Savvas, Athens, Greece
| | - Thomas V Merluzzi
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | | | | | - Anna Deltsidou
- Midwifery Department, University of West Attica, Athens, Greece
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11
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Shin JW, Happ MB, Tate JA. VidaTalk™ patient communication application "opened up" communication between nonvocal ICU patients and their family. Intensive Crit Care Nurs 2021; 66:103075. [PMID: 34127362 PMCID: PMC10833611 DOI: 10.1016/j.iccn.2021.103075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To explore family members' perceptions of an electronic communication application, VidaTalk™, their communication experience, and emotional reactions to communication with mechanically ventilated patients in the intensive care units. RESEARCH METHODOLOGY/DESIGN Qualitative phase of a mixed-methods study nested within a randomised controlled trial. Family members in the intervention group received the VidaTalk™ app as a communication aid during their intensive care stay. Seven family members participated in 18 semi-structured email interviews after discharge between May and December 2018. Interviews were analysed using qualitative content analysis. SETTING Families were recruited in multiple intensive care units located in one university hospital. MAIN OUTCOME MEASURES Communication experience with the VidaTalk™ and emotions while communicating with the patient. Basic qualitative description and constant comparative techniques were used to code and analyse the text using ATLAS_ti (Version 7.5.18). FINDINGS The VidaTalk™ opened up family-patient communication by allowing clear communication and expanding communication content. Family members felt happy and thankful to communicate with the patient. They also expressed feelings of relief and less frustration and less stress while communicating with the patient. On the other hand, the patient's ability to express their worries or anxiety sometimes made families feel sad or distressed. CONCLUSION The VidaTalk™ was helpful for family-patient communication. The VidaTalk™ may help families reduce psychological distress. However, expanded communication with critically ill patients may cause other negative feelings.
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Affiliation(s)
- Ji Won Shin
- Betty Irene Moore School of Nursing, University of California - Davis, Betty Irene Moore Hall, 2570 48th St., Sacramento, CA 95817, USA; College of Nursing, The Ohio State University, Newton Hall #352, 1585 Neil Ave., Columbus, OH 43210, USA.
| | - Mary Beth Happ
- College of Nursing, The Ohio State University, Newton Hall #352, 1585 Neil Ave., Columbus, OH 43210, USA.
| | - Judith A Tate
- College of Nursing, The Ohio State University, Newton Hall #352, 1585 Neil Ave., Columbus, OH 43210, USA.
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12
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Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Rev Neurother 2021; 21:1159-1177. [PMID: 34519235 DOI: 10.1080/14737175.2021.1981289] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Post-intensive care syndrome (PICS) has only recently been recognized as a new clinical entity in patients surviving their intensive care unit (ICU) stay due to critical illness. With increasing survival rates of ICU patients worldwide, there is a rising interest regarding post-ICU recovery. AREAS COVERED First, based on the current literature a definition is provided of PICS, including the domains of impairments that comprise PICS along with the etiology and risk factors. Second, preventive measures and possible treatment strategies integrated in the follow-up care are described. Third, the authors will discuss the current SARS-Cov-2 pandemic and the increased risk of PICS in these post-ICU patients and their families. EXPERT OPINION PICS is a relatively new entity, which not only encompasses various physical, cognitive, and psychological impairments but also impacts global health due to long-lasting detrimental socioeconomic burdens. Importantly, PICS also relates to caregivers of post-ICU patients. Strategies to reduce this burden will not only be needed within the ICU setting but will also have to take place in an interdisciplinary, multifaceted approach in primary care settings. Additionally, the SARS-Cov-2 pandemic has a high burden on post-ICU patients and their relatives.
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Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburg Medisch Centrum Hardenberg, The Netherlands
| | - Emily Aupers
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands
| | - Annemarie Oldenbeuving
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Board, ADRZ (Admiraal De Ruyter Ziekenhuis), Goes, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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13
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Suter P, Wesch C. Erste Evaluation eines Programms zur Frührehabilitation von Langzeitintensivpatient_innen. Pflege 2021; 34:291-299. [PMID: 34463542 DOI: 10.1024/1012-5302/a000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
First evaluation of an early rehabilitation programm for chronically critically ill patients Abstract. Introduction: Chronically critically ill patients are an increasing challenge for teams in intensive care units due to the burden of symptoms and the consumption of resources. Structured multimodal concepts are recommended for nursing care and treatment. A local, interprofessional program for early rehabilitation aims to provide optimal care for patients through a systematic, proactive and holistic treatment process with a rehabilitative focus. The program consists of specific assessments and systematic coordination of interprofessional early rehabilitation. Problem and objective: Interprofessional collaboration requires mutual acceptance and good communication from those involved. The functioning of selected processes as well as the satisfaction of the professionals are topics of a first formative evaluation. Methods: The team evaluated descriptive quality data as well as self-generated structured questionnaires. Results: Specific adjustments were made to the treatment plan for 52 of 112 patients in the program. The assessments are easy to carry out and support systematic early rehabilitation. From the perspective of the professionals involved, both the interprofessional collaboration and their understanding for the patients improved. Discussion and transfer: The program optimizes treatment and promotes good interprofessional collaboration. The formative evaluation provides valuable information for future process changes such as the inclusion of patients as well as further disciplines and program development beyond the boundaries of the intensive care unit.
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Affiliation(s)
- Peter Suter
- Praxisentwicklung und Forschung Therapien, Universitätsspital Basel
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14
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Bohm M, Cronberg T, Årestedt K, Friberg H, Hassager C, Kjaergaard J, Kuiper M, Nielsen N, Ullén S, Undén J, Wise MP, Lilja G. Caregiver burden and health-related quality of life amongst caregivers of out-of-hospital cardiac arrest survivors. Resuscitation 2021; 167:118-127. [PMID: 34437997 DOI: 10.1016/j.resuscitation.2021.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/29/2021] [Accepted: 08/15/2021] [Indexed: 02/02/2023]
Abstract
AIMS To describe burden and health-related quality of life amongst caregivers of out-of-hospital cardiac arrest survivors and explore the potential association with cognitive function of the survivors. Caregivers of patients with ST-elevation myocardial infarction were used as controls. METHODS Data were collected from the cognitive substudy of the Targeted Temperature Management-trial. Caregiver burden was assessed with the 22-item Zarit Burden Interview, with scores ≤20 considered as no burden. Health-related quality of life was assessed with the SF-36v2®, with T-scores 47-53 representing the norm. Cardiac arrest survivors were categorized based on the results from cognitive assessments as having "no cognitive impairment" or "cognitive impairment". RESULTS Follow-up 6 months post event was performed for caregivers of 272 cardiac arrest survivors and 108 matched myocardial infarction controls, included at an intended ratio of 2:1. In general, caregivers of cardiac arrest survivors and controls reported similar caregiver burden. The overall scores for quality of life were within normative levels and similar for caregivers of cardiac arrest survivors and control patients. Compared to those with no cognitive impairment, caregivers of cognitively impaired cardiac arrest survivors (n = 126) reported higher levels of burden (median 18 versus 8, p < 0.001) and worse quality of life in five of eight domains, particularly "Role-Emotional" (mean 45.7 versus 49.5, p = 0.002). CONCLUSIONS In general, caregivers of cardiac arrest survivors and myocardial infarction controls reported similar levels of burden and quality of life. Cognitive outcome and functional dependency of the cardiac arrest survivor impact burden and quality of life of the caregiver.
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Affiliation(s)
- Mattias Bohm
- Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Tobias Cronberg
- Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, and the Research Section, Region Kalmar County, Kalmar, Sweden
| | - Hans Friberg
- Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kuiper
- Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden
| | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | - Johan Undén
- Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund University, Hallands Hospital Halmstad, Halmstad, Sweden
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
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15
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Tate JA, Choi J. Positive Appraisal of Caregiving for Intensive Care Unit Survivors: A Qualitative Secondary Analysis. Am J Crit Care 2020; 29:340-349. [PMID: 32869072 DOI: 10.4037/ajcc2020953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND More than half of intensive care unit survivors require assistance from family caregivers after discharge. Caregiving is associated with negative consequences including poor health-related quality of life, psychosocial distress, and burden. Little is known about how family caregivers find satisfaction and meaning in their experience. OBJECTIVES To explore positive descriptions of the experiences of family caregivers of critically ill patients and to describe factors that family caregivers view as important to a positive caregiving experience from hospitalization to 4 months after discharge. METHODS Qualitative secondary analysis was performed on data from semistructured interviews conducted as part of a longitudinal study that examined physical and psychological responses to stress in a convenience sample of family caregivers of adult intensive care unit patients who underwent prolonged mechanical ventilation (≥ 4 days). Interviews were conducted at 4 time points: during the hospitalization and within 2 weeks, 2 months, and 4 months after discharge. RESULTS Participants (n = 41) reported factors that helped them positively appraise their caregiving experience in 113 interviews conducted face to face or via telephone. During patients' hospitalization, caregivers described changes in their role, with their primary responsibility being to advocate for the patient. They described how this experience fulfilled their identity and strengthened their relationship with the patient. Most family caregivers mentioned the importance of social support and prayer. CONCLUSIONS Family caregivers of intensive care unit patients can identify positive aspects of caregiving during the experience. Interventions to reframe the caregiving experience in a positive light are warranted.
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Affiliation(s)
- Judith A. Tate
- Judith A. Tate is an assistant professor at the Ohio State University College of Nursing, Columbus, Ohio
| | - JiYeon Choi
- JiYeon Choi is an assistant professor at Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, Seoul, Korea. At the time of the study, Choi was at the University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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16
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Abstract
Using Walker and Avant's approach, a concept analysis was performed to develop a working definition of caregiver fatigue. Defining attributes of caregiver fatigue identified were "fell into role" by default, outside the norm of role expectations, excess caregiving demand, and exposure to prolonged period of caregiving. Model, related, and contrary cases were developed. Antecedent, consequences, and empirical referent of caregiver fatigue were also identified. Lastly, a working definition of caregiver fatigue was developed.
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17
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Aşkın A, Atar E, Şengül İ, Tosun A, Demirdal Ü, Elmalı F. Validity and reliability of the Turkish version of caregiver self-assessment questionnaire. Disabil Rehabil 2019; 42:3250-3255. [PMID: 30990351 DOI: 10.1080/09638288.2019.1587525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This study aims to translate the Caregiver Self-Assessment Questionnaire (CSAQ) into Turkish language and to test its reliability and validity in Turkish informal family caregivers.Materials and methods: This is a cross-sectional and methodological study. Eighty family caregivers (54.53 ± 12.07 years; range 25 to 77 years; 65 females, 15 males) were included in the study. Demographic properties of the participants (age, sex, education, occupation, marital status), relationship with care recipient, caregiving time, main diseases of the patients were recorded. After that CSAQ, Caregiver Well-Being Scale (CWBS) and Hospital Anxiety Depression Scale (HADS) were used for data collection. A test-retest interval of seven-days was used to assess the reliability. Internal consistency between the items was assessed by Cronbach's alpha coefficient. For reliability; test-retest reliability, intraclass correlation coefficient, and paired sample t tests were used. Intercorrelation of variables was performed with Spearman's rho tests. A ROC curve and sensitivity and specificity analysis were performed to determine the ability of the CSAQ to predict depression or anxiety.Results: Totally 80 participants completed test/retest procedures. Content Validity Index values of the Items were sufficient and all items were included in the questionnaire. During exploratory factor analysis, 1 factor with eigenvalues greater than 1 were extracted, explaining 62.36% of the total variance. The corrected item total correlation coefficients for Item 2 and Item 5 were found to be <0.3. Therefore, these two items were omitted. Cronbach's α value was found as 0.90 (excellent level). Test-retest reliability (Intraclass correlation coefficient values range: 0.93-0.97) of the CSAQ was found to be excellent. Statistically negative moderate correlations were detected between CSAQ total score and CWBA basic needs and activities of living sub scores (rho = -0.605, rho = -0.523, p < 0.001), while positive strong correlations were detected between HADS depression and anxiety scores (rho = 0.610, rho = 0.651, p < 0.001). CSAQ score of 9 or greater resulted in a sensitivity of 0.56 and a specificity of 0.87 for depression and sensitivity of 0.84 and a specificity of 0.83 for anxiety. According to the scoring instructions of CSAQ with the positivity of any one of four criteria, we found sensitivity of 0.87 for depression and 0.96 for anxiety.Conclusion: The Turkish version of the CSAQ is a valid and reliable questionnaire for evaluating stress-levels of informal family caregivers.Implications for rehabilitationMeasures of caregivers' psychological status are of clinical value.The Caregiver Self-Assessment Questionnaire functions as a screening measure for symptoms of depression and anxiety.The Turkish version of the Caregiver Self-Assessment Questionnaire is a valid and reliable questionnaire for evaluating stress-levels of informal family caregivers.
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Affiliation(s)
- Ayhan Aşkın
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Katip Çelebi University, Izmir, Turkey
| | - Emel Atar
- Department of Physical Medicine and Rehabilitation, University of Health Science, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - İlker Şengül
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Katip Çelebi University, Izmir, Turkey
| | - Aliye Tosun
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Katip Çelebi University, Izmir, Turkey
| | - Ümit Demirdal
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Katip Çelebi University, Izmir, Turkey
| | - Ferhan Elmalı
- Department of Biostatistics, Faculty of Medicine, Katip Çelebi University, Izmir, Turkey
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18
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Wintermann GB, Petrowski K, Weidner K, Strauß B, Rosendahl J. Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: age matters. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:39. [PMID: 30736830 PMCID: PMC6368748 DOI: 10.1186/s13054-019-2321-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/11/2019] [Indexed: 12/25/2022]
Abstract
Background Survivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their partners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using appropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and controlling for contextual factors, is lacking. Methods The present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the health-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-Interdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The Post-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their partners, within up to 6 months after the transfer from acute care ICU to post-acute ICU. Results Clinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of the partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress symptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners compared to female partners or female patients. In younger partners (≤ 57 years), higher values of post-traumatic stress symptoms were associated with a decreased QoL in the patients. Conclusions Mental health screening and psychotherapeutic treatment options should be offered to both the chronically critically ill patients and their partners. Future research is required to address the special needs of younger patient-partner dyads, following protracted ICU treatment. Trial registration German Clinical Trials Register No. DRKS00003386. Registered 13 November 2011 Electronic supplementary material The online version of this article (10.1186/s13054-019-2321-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany.
| | - Katja Petrowski
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany.,Institute of Medical Psychology and Medical Sociology, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Jenny Rosendahl
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
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19
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McPeake J, Hirshberg EL, Christie LM, Drumright K, Haines K, Hough CL, Meyer J, Wade D, Andrews A, Bakhru R, Bates S, Barwise JA, Bastarache J, Beesley SJ, Boehm LM, Brown S, Clay AS, Firshman P, Greenberg S, Harris W, Hill C, Hodgson C, Holdsworth C, Hope AA, Hopkins RO, Howell DCJ, Janssen A, Jackson JC, Johnson A, Kross EK, Lamas D, MacLeod-Smith B, Mandel R, Marshall J, Mikkelsen ME, Nackino M, Quasim T, Sevin CM, Slack A, Spurr R, Still M, Thompson C, Weinhouse G, Wilcox ME, Iwashyna TJ. Models of Peer Support to Remediate Post-Intensive Care Syndrome: A Report Developed by the Society of Critical Care Medicine Thrive International Peer Support Collaborative. Crit Care Med 2019; 47:e21-e27. [PMID: 30422863 PMCID: PMC6719778 DOI: 10.1097/ccm.0000000000003497] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients and caregivers can experience a range of physical, psychologic, and cognitive problems following critical care discharge. The use of peer support has been proposed as an innovative support mechanism. DESIGN We sought to identify technical, safety, and procedural aspects of existing operational models of peer support, among the Society of Critical Care Medicine Thrive Peer Support Collaborative. We also sought to categorize key distinctions between these models and elucidate barriers and facilitators to implementation. SUBJECTS AND SETTING Seventeen Thrive sites from the United States, United Kingdom, and Australia were represented by a range of healthcare professionals. MEASUREMENTS AND MAIN RESULTS Via an iterative process of in-person and email/conference calls, members of the Collaborative defined the key areas on which peer support models could be defined and compared, collected detailed self-reports from all sites, reviewed the information, and identified clusters of models. Barriers and challenges to implementation of peer support models were also documented. Within the Thrive Collaborative, six general models of peer support were identified: community based, psychologist-led outpatient, models-based within ICU follow-up clinics, online, groups based within ICU, and peer mentor models. The most common barriers to implementation were recruitment to groups, personnel input and training, sustainability and funding, risk management, and measuring success. CONCLUSIONS A number of different models of peer support are currently being developed to help patients and families recover and grow in the postcritical care setting.
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Affiliation(s)
- Joanne McPeake
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
- University of Glasgow, Glasgow, United Kingdom
| | - Eliotte L Hirshberg
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT
- Division of Pulmonary and Critical Care, Department of Medicine, University of Utah, Salt Lake City, UT
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Leeann M Christie
- Dell Children's Medical Centre, Austin, TX
- VA Tennessee Valley Healthcare System, Nashville, TN
| | | | - Kimberley Haines
- Western Health, Melbourne, VIC, Australia
- Australia and New Zealand Intensive Care Society Research Centre, Monash University, Melbourne, VIC, Australia
| | - Catherine L Hough
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Joel Meyer
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dorothy Wade
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Rita Bakhru
- Pulmonary, Critical Care, Allergy & Immunologic Diseases, Wake Forest School of Medicine, Winston Salem, NC
| | | | - John A Barwise
- VA Tennessee Valley Healthcare System, Nashville, TN
- Vanderbilt University Medical Center, Nashville, TN
| | - Julie Bastarache
- VA Tennessee Valley Healthcare System, Nashville, TN
- Vanderbilt University Medical Center, Nashville, TN
| | - Sarah J Beesley
- Intermountain Medical Center, Division of Pulmonary and Critical Care, Murray, UT
- Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, UT
| | - Leanne M Boehm
- Vanderbilt University School of Nursing, Nashville, TN
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center, Nashville, TN
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | | | | | - Penelope Firshman
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Steven Greenberg
- Evanston Hospital, NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Wendy Harris
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Carol Hodgson
- Australia and New Zealand Intensive Care Society Research Centre, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | | | | | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT
- Intermountain Medical Center, Division of Pulmonary and Critical Care, Murray, UT
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT
| | - David C J Howell
- Critical Care Unit, University College London NHS Foundation Trust, London, United Kingdom
| | - Anna Janssen
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Erin K Kross
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| | - Daniela Lamas
- Division of Pulmonary and Critical Care Medicine, Brigham & Women's Hospital, Boston, MA
| | | | - Ruth Mandel
- NorthShore University Health System - Evanston Hospital, Chicago, IL
| | | | - Mark E Mikkelsen
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine of the University of Pennsylvania, Pennsylvania, PA
| | - Megan Nackino
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Tara Quasim
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
- University of Glasgow, Glasgow, United Kingdom
| | - Carla M Sevin
- Division of Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew Slack
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Rachel Spurr
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Mary Still
- Emory University Hospital (Emory Healthcare), Atlanta, GA
| | - Carol Thompson
- College of Nursing, University of Kentucky, Lexington, KY
| | - Gerald Weinhouse
- Division of Pulmonary and Critical Care Medicine, Brigham & Women's Hospital, Boston, MA
| | - M Elizabeth Wilcox
- Division of Respirology, Department of Medicine, Toronto Western Hospital, Toronto, ON, Canada
| | - Theodore J Iwashyna
- Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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20
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Stayt LC, Venes TJ. Outcomes and experiences of relatives of patients discharged home after critical illness: a systematic integrative review. Nurs Crit Care 2018; 24:162-175. [PMID: 30560592 DOI: 10.1111/nicc.12403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/27/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients discharged from intensive care may experience psychological and physical deficits resulting in a long and complex rehabilitation upon discharge. Relatives are also vulnerable to psychological pathologies and diminished health-related quality of life following the patients' critical illness. Relatives often provide care during the patients' rehabilitation, which may influence their health. AIM To report the outcomes and experiences of relatives of patients discharged home after critical illness. DESIGN Systematic integrative review. METHODS Electronic databases Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase®, and PsychINFO® were searched using keywords, synonyms, and medical subject headings. Reference lists of articles and critical care journals were manually searched. Studies eligible for inclusion reported primary research and were published in English between 2007 and 2017. Studies were appraised using the Critical Appraisal Skills Programme checklists. Data were extracted and then analysed according to framework. FINDINGS Twenty-five studies were included: 19 quantitative, 4 qualitative, and 1 mixed method study. Three themes were identified: health and well-being, employment and lifestyle, and caregiving role. Health and well-being reports the incidence and significance of psychological morbidity such as post-traumatic stress disorder, anxiety, and depression. Employment and lifestyle describes the impact of caregiving on the relative's ability to work and engage in usual social activities. The final theme describes and discusses the caregiving role in terms of activities of daily living, knowledge and skills, and adaption to the role. CONCLUSIONS There is a significant and meaningful impact on outcomes and experiences of relatives of patients discharged home after critical illness. Relatives' caregiving is embedded within the context of their psychological morbidity and social adjustment. RELEVANCE TO PRACTICE If informal care giving is to be sustainable, there is a need to design effective strategies of supporting families through all stages of the critical illness trajectory.
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Affiliation(s)
- Louise C Stayt
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK
| | - Trevor J Venes
- Adult Intensive Care, Oxford University Hospital Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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21
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Abstract
Research highlights the psychosocial impact of critical illness on family who typically adopt a caregiver role to the survivor. We review evidence on informal caregiver psychosocial outcomes and interventional studies designed to improve them. We argue informal caregivers have distinct and complex needs that differ from patients. Interventional studies ought to be designed for this cohort with careful attention paid to the timing of interventions. We consider the influence of social isolation on recovery and discuss service improvement approaches to build social support networks to enhance recovery, where caregivers and survivors are involved in the design of aftercare programs.
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Victoria 3021, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow G4 0SF, Scotland; School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow G4 0SF, Scotland; School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland
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22
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Choi J, Lingler JH, Donahoe MP, Happ MB, Hoffman LA, Tate JA. Home discharge following critical illness: A qualitative analysis of family caregiver experience. Heart Lung 2018; 47:401-407. [PMID: 29731146 PMCID: PMC6026552 DOI: 10.1016/j.hrtlng.2018.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few studies have longitudinally explored the experience and needs of family caregivers of ICU survivors after patients' home discharge. METHODS Qualitative content analysis of interviews drawn from a parent study that followed family caregivers of adults ICU survivors for 4 months post-ICU discharge. RESULTS Family caregivers (n = 20, all white, 80% woman) viewed home discharge as positive progress, but reported having insufficient time to transition from family visitor to the active caregiver role. Caregivers expressed feelings of relief during the steady recovery of family members' physical and cognitive function. However, the slow pace of improvement conflicted with their expectations. Even after patients achieved independent physical function, emotional needs persisted and these issues contributed to caregivers' anxiety, worry, and view that recovery was incomplete. CONCLUSION Family caregivers of ICU survivors need information and skills to help managing patients' care needs, pacing expectations with actual patients' progress, and caregivers' health needs.
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Affiliation(s)
- JiYeon Choi
- Department of Acute and Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA; Yonsei University College of Nursing, Seoul, Republic of Korea.
| | - Jennifer H Lingler
- Department of Health and Community Systems, University of Pittsburg, School of Nursing, Pittsburgh, PA, USA
| | - Michael P Donahoe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Mary Beth Happ
- Center of Excellence in Critical and Complex Care, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Leslie A Hoffman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Judith A Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
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23
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Dickson A, Karatzias T, Gullone A, Grandison G, Allan D, Park J, Flowers P. Negotiating boundaries of care: an interpretative phenomenological analysis of the relational conflicts surrounding home mechanical ventilation following traumatic spinal cord injury. Health Psychol Behav Med 2018; 6:120-135. [PMID: 34040825 PMCID: PMC8114355 DOI: 10.1080/21642850.2018.1462708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: The aim of this study is to explore the phenomena of mechanical ventilation following traumatic spinal cord injury from three simultaneous perspectives; patients who require full-time mechanical ventilation (n = 8), their informal family carers (n = 8) and their formal carers (n = 11). We focus upon the intra and inter- personal challenges of establishing boundaries within the triad. Design: Qualitative study. Methods: Semi-structured interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). In order to encapsulate the inter-subjective, multi-dimensional and relational aspects of the experience, we focussed on recurrent themes which were independently reported across all three participant groups. Results: One major inter-connected recurrent theme was identified: 1) 'Negotiating boundaries of care and finding a "fit"'. It centres around establishing a 'line', or a boundary, which was imperative for retaining a sense of independence (for patients), a sense of home and privacy (for informal carers) and difficulties balancing complex care provision with the needs of family members so as not to cross that 'line' (for formal carers). Conclusions: The findings highlight the need for focussing on a 'fit' within the triad, balancing boundaries of care in order to establish a productive, satisfactory psycho-social environment for all three participant groups to live and/or work within. Recommendations for both future care provision and future research are suggested.
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Affiliation(s)
- A Dickson
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - T Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - A Gullone
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK
| | - G Grandison
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - D Allan
- Queen Elizabeth National Spinal Injuries for Scotland, Southern General Hospital, Glasgow, UK
| | - J Park
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - P Flowers
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Aslakson RA, Reinke LF, Cox C, Kross EK, Benzo RP, Curtis JR. Developing a Research Agenda for Integrating Palliative Care into Critical Care and Pulmonary Practice To Improve Patient and Family Outcomes. J Palliat Med 2018; 20:329-343. [PMID: 28379812 DOI: 10.1089/jpm.2016.0567] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Palliative care is a medical specialty and philosophy of care that focuses on reducing suffering among patients with serious illness and their family members, regardless of disease diagnosis or prognosis. As critical illness or moderate to severe pulmonary disease confers significant disease-related symptom burdens, palliative care and palliative care specialists can aid in reducing symptom burden and improving quality of life among these patients and their family members. OBJECTIVE The objective of this article is to review the existing gaps in evidence for palliative care in pulmonary disease and critical illness and to use an interdisciplinary working group convened by the National Institutes of Health and the National Palliative Care Research Center to develop a research agenda to address these gaps. METHODS We completed a narrative review of the literature concerning the integration of palliative care into pulmonary and/or critical care. The review was based on recent systematic reviews on these topics as well as a summary of relevant articles identified through hand search. We used this review to identify gaps in current knowledge and develop a research agenda for the future. RESULTS We identified key areas of need and knowledge gaps that should be addressed to improve palliative care for patients with pulmonary and critical illness. These areas include developing and validating patient- and family-centered outcomes, identifying the key components of palliative care that are effective and cost-effective, developing and evaluating different models of palliative care delivery, and determining the effectiveness and cost-effectiveness of palliative care interventions. CONCLUSIONS The goal of this research agenda is to encourage researchers, clinicians, healthcare systems, and research funders to identify research that can address these gaps and improve the lives of patients with pulmonary and critical illness and their family members.
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Affiliation(s)
- Rebecca A Aslakson
- 1 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine , Baltimore, Maryland.,2 Department of Oncology and Palliative Care Program in the Kimmel Comprehensive Cancer Center at Johns Hopkins , Baltimore, Maryland.,3 Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Lynn F Reinke
- 4 Department of Veterans Affairs, Puget Sound Healthcare System , Seattle, Washington.,5 Department of Biobehavioral Nursing and Health Systems, University of Washington , Seattle, Washington
| | - Christopher Cox
- 6 Department of Medicine, Duke University , Durham, North Carolina
| | - Erin K Kross
- 7 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.,8 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington
| | - Roberto P Benzo
- 9 Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, Minnesota
| | - J Randall Curtis
- 7 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.,8 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington
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Douglas SL, Daly BJ, Lipson AR. Differences in Predictions for Survival and Expectations for Goals of Care between Physicians and Family Surrogate Decision Makers of Chronically Critically Ill Adults. RESEARCH & REVIEWS. JOURNAL OF NURSING AND HEALTH SCIENCES 2017; 3:74-84. [PMID: 29911208 PMCID: PMC6003707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to determine the accuracy and concordance between physicians (MDs) and family surrogate decision makers (FSDMs) in predicting 3 month post-hospital patient mortality and concordance in identifying patient goals of care. A prospective cohort study was conducted in 3 intensive care units (ICUs). Two-hundred and sixty-four FSDMs and 54 attending MDs of patients who had resided in the ICU for >3 days were enrolled in the study. Expectation for mortality was measured dichotomously and goals of care were measured using a continuous visual analog scale. A value of 50 represented equal weight placed on goals of survival and QOL. Both MDs and FSDMs had mortality predictions that were lower than actual mortality. For MDs and FSDMs, their mortality predictions were most accurate at study enrollment. Discordance between MD and FSDM goals of care ranged from 36.4% at enrollment to 55.4% 15 days later (p=0.003). Our findings of optimistic prognosis for survival are consistent with the work of others. Our high rate of discordance regarding goals of care provided support for the need to establish standard processes to assure that values of patients and families are solicited and incorporated into treatment discussions for long-stay ICU patients.
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Affiliation(s)
| | | | - Amy R Lipson
- For Correspondence: Lipson AR, Senior Research Associate at the FPB School of Nursing, Case Western Reserve University, 10900 Euclid Ave Cleveland, Ohio 44106, United States, Tel: 216-368-3107;
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A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses. Intensive Crit Care Nurs 2017; 44:67-75. [PMID: 29169879 DOI: 10.1016/j.iccn.2017.08.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/08/2017] [Accepted: 08/25/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Family caregiver involvement may improve patient and family outcomes in the intensive care unit. This study describes critical care nurses' approaches to involving family caregivers in direct patient care. RESEARCH METHODOLOGY & DESIGN This is a qualitative content analysis of text captured through an electronic survey. SETTING A convenience sample of 374 critical care nurses in the United States who were subscribers to one of the American Association of Critical Care Nurses social media sites or electronic newsletters. MAIN OUTCOME MEASURE Critical care nurses' responses to five open-ended questions about their approaches to family involvement in direct patient care. FINDINGS Nurse, patient and family caregiver factors intersected in the context of the professional practice environment and the available resources for family care. Two main themes were identified: "Involving family caregivers in patient care in the intensive care unit requires careful ssessment" and "There are barriers and facilitators to caregiver involvement in patient care in the intensive care unit." CONCLUSION Patient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research.
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Choi J, Donahoe MP, Hoffman LA. Psychological and Physical Health in Family Caregivers of Intensive Care Unit Survivors: Current Knowledge and Future Research Strategies. J Korean Acad Nurs 2017; 46:159-67. [PMID: 27182013 DOI: 10.4040/jkan.2016.46.2.159] [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] [Received: 12/14/2015] [Accepted: 03/31/2016] [Indexed: 11/09/2022]
Abstract
PURPOSE This article provides an overview of current knowledge on the impact of caregiving on the psychological and physical health of family caregivers of intensive care unit (ICU) survivors and suggestions for future research. METHODS Review of selected papers published in English between January 2000 and October 2015 reporting psychological and physical health outcomes in family caregivers of ICU survivors. RESULTS In family caregivers of ICU survivors followed up to five years after patients' discharge from an ICU, psychological symptoms, manifested as depression, anxiety and post-traumatic stress disorder, were highly prevalent. Poor self-care, sleep disturbances and fatigue were identified as common physical health problems in family caregivers. Studies to date are mainly descriptive; few interventions have targeted family caregivers. Further, studies that elicit unique needs of families from diverse cultures are lacking. CONCLUSION Studies to date have described the impact of caregiving on the psychological and physical health in family caregivers of ICU survivors. Few studies have tested interventions to support unique needs in this population. Therefore, evidence for best strategies is lacking. Future research is needed to identify ICU caregivers at greatest risk for distress, time points to target interventions with maximal efficacy, needs of those from diverse cultures and test interventions to mitigate family caregivers' burden.
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Affiliation(s)
- Jiyeon Choi
- Department of Acute & Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Michael P Donahoe
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Leslie A Hoffman
- Department of Acute & Tertiary Care, School of Nursing & Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Torres J, Carvalho D, Molinos E, Vales C, Ferreira A, Dias CC, Araújo R, Gomes E. The impact of the patient post-intensive care syndrome components upon caregiver burden. Med Intensiva 2017; 41:454-460. [PMID: 28188064 DOI: 10.1016/j.medin.2016.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/25/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate patient post-intensive care syndrome (PICS-P) and caregiver burden 3 months after discharge from the Intensive Care Unit (ICU) and determine the impact of different components of PICS-P upon caregiver burden. DESIGN A prospective observational study was conducted over 26 months (January 2013-February 2015). SETTING Medical-surgical ICU and follow-up consultation in Portugal. PATIENTS OR PARTICIPANTS Patients discharged after a minimum of 2 days in the ICU. Caregiver inclusion criteria: not paid, written and spoken Portuguese, and agreement to participate in the study. MAIN VARIABLES OF INTEREST In ICU: Patient gender, age, severity of illness (SAPS II) and length of ICU stay. At 3 months caregiver burden, physical (reduced mobility, weakness acquired in the ICU) and psychological components of PICS (anxiety, depression, post-traumatic stress disorder). RESULTS A total of 168 caregivers completed the survey (response rate of 69%). A low degree of overburden was reported by 34.5% of caregivers, while 15.5% showed moderate to high levels of overburden. Patient anxiety and depression 3 months after ICU discharge significantly influenced the presence of caregiver burden (p=0.030 vs p=0.008). When physical components of PICS-P were evaluated, no influence on caregiver burden was observed. Patient demographics, severity of illness and length of stay also failed to influence caregiver burden. CONCLUSIONS The presence of psychological components of PICS-P 3 months after ICU seems to have a negative impact upon caregiver burden. On the other hand, physical problems showed no important impact upon caregiver overburden.
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Affiliation(s)
- J Torres
- Intensive Care Unit, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr. Eduardo Torres, 4464-513 Matosinhos, Portugal.
| | - D Carvalho
- Intensive Care Unit, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr. Eduardo Torres, 4464-513 Matosinhos, Portugal
| | - E Molinos
- Intensive Care Unit, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr. Eduardo Torres, 4464-513 Matosinhos, Portugal
| | - C Vales
- Intensive Care Unit, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr. Eduardo Torres, 4464-513 Matosinhos, Portugal
| | - A Ferreira
- Intensive Care Unit, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr. Eduardo Torres, 4464-513 Matosinhos, Portugal
| | - C C Dias
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - R Araújo
- Intensive Care Unit, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr. Eduardo Torres, 4464-513 Matosinhos, Portugal
| | - E Gomes
- Intensive Care Unit, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr. Eduardo Torres, 4464-513 Matosinhos, Portugal
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Dehkordi LM, Babashahi M, Irajpour A. Nonprofessional Care in Chronic Critically Ill Patient: A Qualitative Study. Int J Prev Med 2016; 7:125. [PMID: 28028426 PMCID: PMC5159692 DOI: 10.4103/2008-7802.195209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 10/04/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Decision-making about patients with critical condition transfer from Intensive Care Unit to the general wards be delegated to their families. The aim of the study was explaining the experiences of family caregiver's about care of chronic critically ill patient. METHODS This study was conducted with a qualitative content analysis using unstructured interview. Participants were selected purposively from May 2014 to May 2015 and data collection continued until data saturation. Analysis was based on conventional content analysis. RESULTS Participants' experiences classified into three main categories as following: nonprofessional care, enhancing factors of care, and inhibiting factors of care. CONCLUSIONS Finding of the current study showed different aspects of care. Care of chronic critically ill patients is a long-term process that affected by different factors. It seems that the exploration of caregivers needs and planning supportive interventions based on their needs improve the quality of care.
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Affiliation(s)
- Leila Mardanian Dehkordi
- Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Monireh Babashahi
- Nursing and Midwifery Sciences Development Research Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Alireza Irajpour
- Nursing and Midwifery Care Research Centre, Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Social Determinants of Health Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
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30
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Kao YY, Chen CI, Chen FJ, Lin YH, Perng SJ, Lin HY, Huang CY. Effects of Resourcefulness on Sleep Disturbances, Anxiety, and Depressive symptoms in Family Members of Intensive Care Unit Patients. Arch Psychiatr Nurs 2016; 30:607-13. [PMID: 27654246 DOI: 10.1016/j.apnu.2016.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/24/2016] [Accepted: 02/13/2016] [Indexed: 11/25/2022]
Abstract
The study aimed to investigate the relationships among psychological distresses, resourcefulness, sleep disturbances, anxiety and depressive symptoms in family members of intensive care unit (ICU) patients. A cross-sectional, descriptive correlational design was employed. Using structural equation modeling (SEM) approach, relationships among factors, mediators, and outcomes were analyzed. The SEM explained 59% of the variances in depressive symptoms and 36% in anxiety. Family members with greater learned resourcefulness had fewer sleep disturbances, depressive and anxiety symptoms. Nursing professionals need to detect psychiatric disease of family members and must be especially vigilant with people who have low resourcefulness and sleep disturbances.
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Affiliation(s)
- Yu-Yin Kao
- Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Fen-Ju Chen
- Department of Healthcare Administration, I-Shou University
| | | | | | - Hung-Yu Lin
- Medical College, I-Shou University, Kaohsiung, Taiwan; Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
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31
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Oh EG, Lee HJ, Yang YL, Kim YM. Significance of depression in family caregivers of critically ill patients discharged home. J Thorac Dis 2016; 8:E1232-E1234. [PMID: 27867595 PMCID: PMC5107545 DOI: 10.21037/jtd.2016.10.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/19/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Eui Geum Oh
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - Hyun Joo Lee
- Graduate School, Yonsei University College of Nursing, Seoul, Korea
| | - You Lee Yang
- Graduate School, Yonsei University College of Nursing, Seoul, Korea
| | - Young Man Kim
- Graduate School, Yonsei University College of Nursing, Seoul, Korea
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Sleep in family caregivers of ICU survivors for two months post-ICU discharge. Intensive Crit Care Nurs 2016; 37:11-18. [PMID: 27575618 PMCID: PMC5056142 DOI: 10.1016/j.iccn.2016.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/28/2016] [Accepted: 07/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe changes in sleep quality in family caregivers of ICU survivors from the patients' ICU admission until two months post-ICU discharge. DESIGN Descriptive repeated measure design. SETTING Academic hospital medical ICU. MAIN OUTCOME MEASURES Subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and objective sleep/wake variables (SenseWear Armband™) were measured in family caregivers at patients' ICU admission, within two weeks post-ICU discharge and two months post-ICU discharge. RESULTS In 28 family caregivers of ICU survivors, most caregivers reported poor sleep quality (i.e. PSQI >5) across the three time points (64.3% during patients' ICU admission, 53.6% at each post-ICU time point). Worse trends in sleep quality and objective sleep/wake pattern were observed in caregivers who were employed, and a non-spouse. There were trends of worsening sleep quality in caregivers of patients unable to return home within two months post-ICU discharge compared to patients able to return home. CONCLUSIONS Poor sleep quality was highly prevalent and persisted in family caregivers of ICU survivors for two months post-ICU discharge. Our data support the need for a larger longitudinal study to examine risk factors associated with sleep quality in family caregivers of ICU survivors to develop targeted interventions.
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Wintermann GB, Weidner K, Strauß B, Rosendahl J, Petrowski K. Predictors of posttraumatic stress and quality of life in family members of chronically critically ill patients after intensive care. Ann Intensive Care 2016; 6:69. [PMID: 27439709 PMCID: PMC4954797 DOI: 10.1186/s13613-016-0174-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/07/2016] [Indexed: 12/22/2022] Open
Abstract
Background Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. Methods In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. Results A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053–.470) and the patients’ diagnosis of PTSD (β = .264, 95 % confidence interval .045–.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = −.231, 95 % confidence interval −.423 to −.015). Regarding HRQL in family members, patients’ acute posttraumatic stress at ICU (β = −.290, 95 % confidence interval −.360 to −.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = −.622, 95 % confidence interval −.640 to −.358) turned out to be significant predictors. Conclusions Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0174-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.,Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Stoystr. 3, 07743, Jena, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Stoystr. 3, 07743, Jena, Germany
| | - Jenny Rosendahl
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Stoystr. 3, 07743, Jena, Germany.
| | - Katja Petrowski
- Department of Workplace Health Promotion, German Sport University Cologne, Cologne, Germany.
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McPeake J, Devine H, MacTavish P, Fleming L, Crawford R, Struthers R, Kinsella J, Daniel M, Shaw M, Quasim T. Caregiver strain following critical care discharge: An exploratory evaluation. J Crit Care 2016; 35:180-4. [PMID: 27481756 DOI: 10.1016/j.jcrc.2016.05.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this exploratory evaluation was to understand the impact of critical care survivorship on caregivers. DESIGN Family members who attended a quality improvement initiative within our critical care unit were asked to complete 4 questionnaires. SETTING The setting for this study was a 20-bedded mixed critical care unit in a large teaching hospital in Scotland. Data were collected as a part of an evaluation of a quality improvement initiative. PARTICIPANTS Thirty-six carers completed the questionnaire set. MEASUREMENTS AND MAIN RESULTS A total of 53% of caregivers suffered significant strain. Poor quality of life in the patient was significantly associated with higher caregiver strain (P= .006). Anxiety was present in 69% of caregivers. Depression was present in 56% of caregivers, with a significant association between carer strain and depression (P< .001). Those caregivers who were defined as being strained also had significantly higher Insomnia Severity Index scores than those without carers strain (P= .007). CONCLUSION This evaluation has demonstrated that there is a significant burden for caregivers of critical care survivors. Furthermore, they reported high levels of posttraumatic stress disorder, anxiety, depression, and insomnia. Future work on rehabilitation from critical care should focus on the inclusion of caregivers.
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Affiliation(s)
- Joanne McPeake
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom; University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Bldg, 10-16 Alexandra Parade, Glasgow, G31 2ER, United Kingdom
| | - Helen Devine
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Pamela MacTavish
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Leanne Fleming
- University of the West of Scotland, Department of Psychology, Paisley Campus, Paisley, Scotland, PA1-2BE, United Kingdom
| | - Rebecca Crawford
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Ruth Struthers
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - John Kinsella
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom; University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Bldg, 10-16 Alexandra Parade, Glasgow, G31 2ER, United Kingdom
| | - Malcolm Daniel
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Martin Shaw
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Tara Quasim
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom; University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Bldg, 10-16 Alexandra Parade, Glasgow, G31 2ER, United Kingdom
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van Beusekom I, Bakhshi-Raiez F, de Keizer NF, Dongelmans DA, van der Schaaf M. Reported burden on informal caregivers of ICU survivors: a literature review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:16. [PMID: 26792081 PMCID: PMC4721206 DOI: 10.1186/s13054-016-1185-9] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Critical illness and the problems faced after ICU discharge do not only affect the patient, it also negatively impacts patients' informal caregivers. There is no review which summarizes all types of burden reported in informal caregivers of ICU survivors. It is important that the burdens these informal caregivers suffer are systematically assessed so the caregivers can receive the professional care they need. We aimed to provide a complete overview of the types of burdens reported in informal caregivers of adult ICU survivors, to make recommendations on which burdens should be assessed in this population, and which tools should be used to assess them. METHOD We performed a systematic search in PubMed and CINAHL from database inception until June 2014. All articles reporting on burdens in informal caregivers of adult ICU survivors were included. Two independent reviewers used a standardized form to extract characteristics of informal caregivers, types of burdens and instruments used to assess these burdens. The quality of the included studies was assessed using the Newcastle-Ottawa and the PEDro scales. RESULTS The search yielded 2704 articles, of which we included 28 in our review. The most commonly reported outcomes were psychosocial burden. Six months after ICU discharge, the prevalence of anxiety was between 15% and 24%, depression between 4.7% and 36.4% and post-traumatic stress disorder (PTSD) between 35% and 57.1%. Loss of employment, financial burden, lifestyle interference and low health-related quality of life (HRQoL) were also frequently reported. The most commonly used tools were the Hospital Anxiety and Depression Scale (HADS), Centre for Epidemiological Studies-Depression questionnaire, and Impact of Event Scale (IES). The quality of observational studies was low and of randomized studies moderate to fair. CONCLUSIONS Informal caregivers of ICU survivors suffer a substantial variety of burdens. Although the quality of the included studies was poor, there is evidence that burden in the psychosocial field is most prevalent. We suggest screening informal caregivers of ICU survivors for anxiety, depression, PTSD, and HRQoL using respectively the HADS, IES and Short Form 36 and recommend a follow-up period of at least 6 months.
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Affiliation(s)
- Ilse van Beusekom
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,National Intensive Care Evaluation, Amsterdam, The Netherlands.
| | - Ferishta Bakhshi-Raiez
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,National Intensive Care Evaluation, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,National Intensive Care Evaluation, Amsterdam, The Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam School of Health Professions, University of Applied Sciences, Amsterdam, The Netherlands
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Ågård AS, Egerod I, Tønnesen E, Lomborg K. From spouse to caregiver and back: a grounded theory study of post-intensive care unit spousal caregiving. J Adv Nurs 2015; 71:1892-903. [DOI: 10.1111/jan.12657] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Sophie Ågård
- Department of Anesthesiology and Intensive Care; Aarhus University Hospital; Denmark
| | - Ingrid Egerod
- University of Copenhagen, Health & Medical Sciences; Copenhagen University Hospital Rigshospitalet; Trauma Center; Denmark
| | - Else Tønnesen
- Department of Anesthesiology and Intensive Care; Aarhus University Hospital; Denmark
| | - Kirsten Lomborg
- Faculty of Health Sciencies & Aarhus University Hospital; Aarhus University; Denmark
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Abdalrahim MS, Zeilani RS. Jordanian survivors' experiences of recovery from critical illness: a qualitative study. Int Nurs Rev 2014; 61:570-7. [PMID: 25382166 DOI: 10.1111/inr.12142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the fact that a lot of patients consider their discharge from hospitals as a positive sign of progress towards regained health, many of them start suffering from physical, psychological and social problems after discharge from intensive care units. AIM This study aims to describe the experiences of Jordanian survivors of critical illnesses 3 months after discharge from a hospital intensive care unit. METHODS A descriptive qualitative approach was used to involve 18 Jordanian patients from two hospitals in a major Jordanian city using open-ended interviews. Interview transcripts were analysed using content analysis method. RESULTS Three main themes have emerged from the data: (1) new meaning of life; (2) different perspectives on the meaning of life, and (3) struggle for role identity. LIMITATION The sample was chosen from one city in Jordan; longitudinal study might help identify the change in patients' experiences over time. CONCLUSION Patients described the discharge from the intensive care unit as a means of rescue from death; they began to value their spiritual and religious rituals. Negative traumatic experiences hindered the patients' recovery process. During recovery, patients struggled to resume their power and role in family. IMPLICATIONS FOR NURSES AND HEALTH POLICY This study emphasizes the importance of providing care according to the patient's individual needs, related to their cultural and spiritual milieu; there is a need to develop follow-up services for ICU survivors within a national health policy. Further educational and training programmes in the patient's issues after discharge from hospital are needed. This will definitely help nurses care after this patient group.
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Affiliation(s)
- M S Abdalrahim
- Clinical Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
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Jurasinski P, Schindler CA. An emerging population: the chronically critically ill. J Pediatr Health Care 2014; 28:550-4. [PMID: 24929844 DOI: 10.1016/j.pedhc.2014.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 04/09/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
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Abstract
OBJECTIVES Palliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation. DATA SOURCES We searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-searched reference lists and author files. STUDY SELECTION Selected studies included all English-language articles concerning adult patients using the search terms 'intensive care' or 'critical care' with 'palliative care,' 'supportive care,' 'end-of-life care,' or 'ethics.' DATA EXTRACTION : After examination of peer-reviewed original scientific articles, consensus statements, guidelines, and reviews resulting from our literature search, we made final selections based on author consensus. DATA SYNTHESIS Existing evidence is organized to address: 1) opportunities to alleviate physical and emotional symptoms, improve communication, and provide support for patients and families; 2) models and specific interventions for improving ICU palliative care; 3) available resources for ICU palliative care improvement; and 4) ongoing challenges and targets for future research. Key domains of ICU palliative care have been defined and operationalized as measures of quality. There is increasing recognition that effective integration of palliative care during acute and chronic critical illness may help patients and families face challenges after discharge from intensive care. CONCLUSIONS Palliative care is increasingly accepted as an essential component of comprehensive care for critically ill patients, regardless of diagnosis or prognosis. A variety of strategies to improve ICU palliative care appear to be effective, and resources including technical assistance and tools are available to support improvement efforts. As the longer-term impact of intensive care on those surviving acute critical illness is increasingly documented, palliative care can help prepare and support patients and families for challenges after ICU discharge. Further research is needed to inform efforts to integrate palliative care with intensive care more effectively and efficiently in and after the ICU and to document improvement using valid and responsive outcome measures.
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Affiliation(s)
- Rebecca A Aslakson
- 1Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD. 2The Palliative Care Program at the Kimmel Cancer Center at Johns Hopkins, The Johns Hopkins School of Medicine, Baltimore, MD. 3Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA. 4Division of Pulmonary, Critical Care and Sleep Medicine and Hertzberg Palliative Care Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Choi J, Hoffman LA, Schulz R, Tate JA, Donahoe MP, Ren D, Given BA, Sherwood PR. Self-reported physical symptoms in intensive care unit (ICU) survivors: pilot exploration over four months post-ICU discharge. J Pain Symptom Manage 2014; 47:257-70. [PMID: 23856099 PMCID: PMC3800224 DOI: 10.1016/j.jpainsymman.2013.03.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/25/2013] [Accepted: 03/29/2013] [Indexed: 12/01/2022]
Abstract
CONTEXT Survivors of critical illness must overcome persistent physical and psychological challenges. Few studies have longitudinally examined self-reported physical symptoms in intensive care unit (ICU) survivors. OBJECTIVES To describe prevalence and severity of self-reported symptoms in 28 adult medical ICU survivors during the first four months post-ICU discharge and their associations with family caregiver responses. METHODS Patients completed the Modified Given Symptom Assessment Scale. Caregivers completed the Shortened 10-item Center for Epidemiologic Studies Depression Scale, Brief Zarit Burden Score, Pittsburgh Sleep Quality Index, and the Caregiver Health Behavior form. Data at ICU discharge (two weeks or less), and two and four months post-ICU discharge were analyzed. RESULTS Across the time points, most patients reported one or more symptoms (88.5-97%), with sleep disturbance, fatigue, weakness, and pain the most prevalent. For these four symptoms with the highest prevalence, there were: 1) moderate correlations among symptom severity at two and four months post-ICU discharge; and 2) no difference in prevalence or severity by patients' disposition (home vs. institution), except worse fatigue in patients at home at two weeks or less post-ICU discharge. Patients' overall symptom burden showed significant correlation with caregivers' depressive symptoms two weeks or less post-ICU discharge. There were trends of moderate correlations between patients' overall symptom burden and caregivers' health risk behaviors and sleep quality at two and four months post-ICU discharge. CONCLUSION In our sample, sleep disturbance, fatigue, weakness, and pain were the four key symptoms during first four months post-ICU discharge. Future studies focusing on these four symptoms are necessary to promote quality in post-ICU symptom management.
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Affiliation(s)
- JiYeon Choi
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.
| | - Leslie A Hoffman
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard Schulz
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Judith A Tate
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael P Donahoe
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dianxu Ren
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Barbara A Given
- College of Nursing, The Michigan State University, East Lansing, Michigan, USA
| | - Paula R Sherwood
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Garcia RP, Budó MDLD, Simon BS, Wünsch S, Oliveira SG, Barbosa MDS. Vivências da família após infarto agudo do miocárdio. Rev Gaucha Enferm 2013; 34:171-8. [DOI: 10.1590/s1983-14472013000300022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivou-se descrever as vivências da família no pós-infarto. Pesquisa qualitativa, descritiva e exploratória, realizada com seis famílias de pacientes pós-infarto. A coleta de dados ocorreu no domicílio das famílias, no período de fevereiro a maio de 2012, por meio de observação e entrevista com a família. Foi utilizado o software Atlas Ti 6.2 na codificação das entrevistas e os dados foram explorados com a análise temática. Surgiram duas categorias: "Tempos difíceis": consequência imediata do infarto agudo do miocárdio para as famílias; e "Nos reeducamos - a gente se adapta", vivência atual das famílias. A vivência imediata pós-infarto é permeada por variados sentimentos, necessitando adaptação das famílias para adequação às necessidades. A vivência atual demonstra modificações nas famílias devido à enfermidade. A família é a principal responsável pelas práticas de cuidado, porém a Enfermagem deve atuar na troca e no compartilhamento de saberes.
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Griffiths J, Hatch RA, Bishop J, Morgan K, Jenkinson C, Cuthbertson BH, Brett SJ. An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R100. [PMID: 23714692 PMCID: PMC3706775 DOI: 10.1186/cc12745] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 05/24/2013] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The socio-economic impact of critical illnesses on patients and their families in Europe has yet to be determined. The aim of this exploratory study was to estimate changes in family circumstances, social and economic stability, care requirements and access to health services for patients during their first 12 months after ICU discharge. METHODS Multi-center questionnaire-based study of survivors of critical illness at 6 and 12 months after ICU discharge. RESULTS Data for 293 consenting patients who spent greater than 48 hours in one of 22 UK ICUs were obtained at 6 and 12 months post-ICU discharge. There was little evidence of a change in accommodation or relationship status between pre-admission and 12 months following discharge from an ICU. A negative impact on family income was reported by 33% of all patients at 6 months and 28% at 12 months. There was nearly a 50% reduction in the number of patients who reported employment as their sole source of income at 12 months (19% to 11%) compared with pre-admission. One quarter of patients reported themselves in need of care assistance at 6 months and 22% at 12 months. The majority of care was provided by family members (80% and 78%, respectively), for half of whom there was a negative impact on employment. Amongst all patients receiving care, 26% reported requiring greater than 50 hours a week. Following discharge, 79% of patients reported attending their primary care physician and 44% had seen a community nurse. Mobility problems nearly doubled between pre-admission and 6 months (32% to 64%). Furthermore, 73% reported moderate or severe pain at 12 months and 44% remained significantly anxious or depressed. CONCLUSIONS Survivors of critical illness in the UK face a negative impact on employment and commonly have a care requirement after discharge from hospital. This has a corresponding negative impact on family income. The majority of the care required is provided by family members. This effect was apparent by 6 months and had not materially improved by 12 months. This exploratory study has identified the potential for a significant socio-economic burden following critical illness.
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Nelson JE, Hope AA. Integration of palliative care in chronic critical illness management. Respir Care 2012; 57:1004-12; discussion 1012-3. [PMID: 22663973 DOI: 10.4187/respcare.01624] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Palliative care is an essential component of comprehensive care for all patients with chronic critical illness, including those receiving restorative or life-sustaining therapies. Core elements include alleviation of symptom distress, communication about care goals, alignment of treatment with the patient's values and preferences, transitional planning, and family support. Here we address strategies for assessment and management of symptoms, including pain, dyspnea, and depression, and for assisting patients to communicate while endotracheally intubated. We also discuss approaches to optimize communication among clinicians, patients, and families about care goals. Challenges for supporting families and planning for transitions between care settings are identified, while the value of interdisciplinary input is emphasized. We review "consultative" and "integrative" models for integrating palliative care and restorative critical care. Finally, we highlight key ethical issues that arise in the care of chronically critically ill patients and their families.
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Affiliation(s)
- Judith E Nelson
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
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Patterns of depressive symptoms in caregivers of mechanically ventilated critically ill adults from intensive care unit admission to 2 months postintensive care unit discharge: a pilot study. Crit Care Med 2012; 40:1546-53. [PMID: 22430242 DOI: 10.1097/ccm.0b013e3182451c58] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine trajectories of depressive symptoms in caregivers of critically ill adults from intensive care unit admission to 2 months postintensive care unit discharge and explore patient and caregiver characteristics associated with differing trajectories. DESIGN Longitudinal descriptive study. SETTING Medical intensive care unit in a tertiary university hospital. SUBJECTS Fifty caregivers and 47 patients on mechanical ventilation for ≥4 days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Caregivers completed measures assessing depressive symptoms (Short version Center for Epidemiologic Studies-Depression Scale 10-items), burden (Brief Zarit Burden Interview), and health risk behaviors (caregiver health behaviors) during intensive care unit admission, at intensive care unit discharge, and 2 months postintensive care unit discharge. Group-based trajectory analysis was used to identify patterns of change in shortened Center for Epidemiologic Studies-Depression Scale scores over time. Two trajectory groups emerged: 1) caregivers who had clinically significant depressive symptoms (21.0±4.1) during intensive care unit admission that remained high (13.6±5) at 2 months postintensive care unit discharge (high trajectory group, 56%); and 2) caregivers who reported scores that were lower (10.6±5.7) during intensive care unit admission and decreased further (5.7±3.6) at 2 months postintensive care unit discharge (low trajectory group, 44%). Caregivers in the high trajectory group tended to be younger, female, an adult child living with financial difficulty, and less likely to report a religious background or preference. More caregivers in the high trajectory group reported greater burden and more health risk behaviors at all time points; patients tended to be male with poorer functional ability at intensive care unit discharge. Caregivers' responses during intensive care unit admission did not differ in regard to number of days patients were on mechanical ventilation before enrollment. CONCLUSION Findings suggest two patterns of depressive symptom response in caregivers of critically ill adults on mechanical ventilation from intensive care unit admission to 2 months postintensive care unit discharge. Future studies are necessary to confirm these findings and implications for providing caregiver support.
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Jones C, Bäckman C, Griffiths RD. Intensive care diaries and relatives' symptoms of posttraumatic stress disorder after critical illness: a pilot study. Am J Crit Care 2012; 21:172-6. [PMID: 22549573 DOI: 10.4037/ajcc2012569] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Relatives of patients recovering from critical illness are at risk of developing posttraumatic stress disorder. OBJECTIVES To test whether providing a diary to intensive care patients and their relatives reduces the level of symptoms related to posttraumatic stress disorder in the relatives. METHODS Observational study of close family members of patients who stayed more than 72 hours in an intensive care unit, recruited in 2 centers of a 12-center randomized controlled trial examining the effect of a diary outlining the details of the patients' stay in the intensive care unit on the development of new-onset posttraumatic stress disorder in patients. The close family members of the patients were recruited to examine the additional effect of the provision of the patient's diary on the family members' symptoms related to posttraumatic stress syndrome. RESULTS Thirty-six family members were recruited, and 30 completed the study. Family members of patients who received their diary at 1 month had lower levels of symptoms related to posttraumatic stress disorder (P = .03) at the 3-month follow-up than did the control family members. CONCLUSIONS Provision of a diary may help psychological recovery in patients' families after critical illness.
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Affiliation(s)
- Christina Jones
- Christina Jones is a nurse consultant in critical care rehabilitation in the intensive care unit at Whiston Hospital in Prescot, United Kingdom. Carl Bäckman is a critical care nurse at Vrinnevisjukhuset in Norrköping, Sweden. Richard David Griffiths is a a professor of intensive care at the University of Liverpool and a consultant at Whiston Hospital in Prescot, United Kingdom
| | - Carl Bäckman
- Christina Jones is a nurse consultant in critical care rehabilitation in the intensive care unit at Whiston Hospital in Prescot, United Kingdom. Carl Bäckman is a critical care nurse at Vrinnevisjukhuset in Norrköping, Sweden. Richard David Griffiths is a a professor of intensive care at the University of Liverpool and a consultant at Whiston Hospital in Prescot, United Kingdom
| | - Richard David Griffiths
- Christina Jones is a nurse consultant in critical care rehabilitation in the intensive care unit at Whiston Hospital in Prescot, United Kingdom. Carl Bäckman is a critical care nurse at Vrinnevisjukhuset in Norrköping, Sweden. Richard David Griffiths is a a professor of intensive care at the University of Liverpool and a consultant at Whiston Hospital in Prescot, United Kingdom
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Ågård A, Egerod I, Tønnesen E, Lomborg K. Struggling for independence: A grounded theory study on convalescence of ICU survivors 12 months post ICU discharge. Intensive Crit Care Nurs 2012; 28:105-13. [DOI: 10.1016/j.iccn.2012.01.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 01/06/2012] [Accepted: 01/23/2012] [Indexed: 11/28/2022]
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Gay EB, Weiss SP, Nelson JE. Integrating palliative care with intensive care for critically ill patients with lung cancer. Ann Intensive Care 2012; 2:3. [PMID: 22339793 PMCID: PMC3306209 DOI: 10.1186/2110-5820-2-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/16/2012] [Indexed: 01/22/2023] Open
Abstract
With newer information indicating more favorable outcomes of intensive care therapy for lung cancer patients, intensivists increasingly are willing to initiate an aggressive trial of this therapy. Concerns remain, however, that the experience of the intensive care unit for patients with lung cancer and their families often may be distressing. Regardless of prognosis, all patients with critical illness should receive high-quality palliative care, including symptom control, communication about appropriate care goals, and support for both patient and family throughout the illness trajectory. In this article, we suggest strategies for integrating palliative care with intensive care for critically ill lung cancer patients. We address assessment and management of symptoms, knowledge and skill needed for effective communication, and interdisciplinary collaboration for patient and family support. We review the role of expert consultants in providing palliative care in the intensive care unit, while highlighting the responsibility of all critical care clinicians to address basic palliative care needs of patients and their families.
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Affiliation(s)
- Elizabeth B Gay
- Department of Pulmonary and Critical Care Medicine, University of Virginia Health Systems, Charlottesville, VA
| | - Stefanie P Weiss
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY
| | - Judith E Nelson
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY
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Intensive care unit survivorship: varying outcomes dependent on patient characteristics. Crit Care Med 2011; 39:2002-4. [PMID: 21768807 DOI: 10.1097/ccm.0b013e318224994b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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