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Moale AC, Motter EM, Eisenhauer P, Gandhi N, Kim SP, Girard TD, Reynolds CF, Leland NE, Chang JC, Scheunemann LP. Integrating Perspectives on Family Caregiving After Critical Illness: A Qualitative Content Analysis. Am J Crit Care 2024; 33:180-189. [PMID: 38688852 DOI: 10.4037/ajcc2024309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND To date, no intervention has definitively improved outcomes for families of critical illness survivors. An integrated perspective on caregivers' needs after critical illness could help identify high-priority intervention targets and improve outcomes. OBJECTIVES To obtain diverse perspectives on the needs, barriers and facilitators, and social determinants of health associated with family caregiving across the critical illness continuum and assess the extent to which successful caregiving interventions in other populations may be adapted to the critical illness context. METHODS This qualitative content analysis of 31 semistructured interviews and 10 focus groups with family caregivers, health care providers, and health care administrators explored family caregivers' needs during post- intensive care unit (ICU) transitions and the barriers and facilitators associated with addressing them. Trained coders analyzed transcripts, identified patterns and categories among the codes, and generated themes. RESULTS Caregivers have 3 instrumental needs: formal and informal support, involvement in care planning, and education and training. Only caregivers described their self-care and mental health needs. Social determinants of health are the key barriers and facilitators shaping the caregivers' journey, and caregiving as a social determinant of health was a prominent theme. CONCLUSIONS Caregivers have instrumental, self-care, and mental health needs after critical illness. Adapting hands-on and skills training interventions to the post-ICU setting, while tailoring interventions to caregivers' health-related social context, may improve caregiver outcomes.
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Affiliation(s)
- Amanda C Moale
- Amanda C. Moale is a pulmonary and critical care medicine fellow, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Erica M Motter
- Erica M. Motter is a research coordinator, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter Eisenhauer
- Peter Eisenhauer is an internist, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nimit Gandhi
- Nimit Gandhi is an internist, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - S Peter Kim
- S. Peter Kim is an internist, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tim D Girard
- Tim D. Girard is a professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Charles F Reynolds
- Charles F. Reynolds III is an emeritus professor, Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center
| | - Natalie E Leland
- Natalie E. Leland is a professor, Department of Occupational Therapy, University of Pittsburgh
| | - Judy C Chang
- Judy C. Chang is a professor, Department of Obstetrics, Gynecology, and Reproductive Sciences and General Internal Medicine and Clinical and Translational Science Institute, University of Pittsburgh School of Medicine
| | - Leslie P Scheunemann
- Leslie P. Scheunemann is an assistant professor, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh Medical Center; and Division of Geriatric Medicine and Gerontology, University of Pittsburgh
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Wendlandt B, Edwards T, Hughes S, Gaynes BN, Carson SS, Hanson LC, Toles M. Novel Definitions of Wellness and Distress among Family Caregivers of Patients with Acute Cardiorespiratory Failure: A Qualitative Study. Ann Am Thorac Soc 2024; 21:782-793. [PMID: 38285875 PMCID: PMC11109912 DOI: 10.1513/annalsats.202310-904oc] [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] [Received: 10/24/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
Rationale: Family caregivers of patients with acute cardiorespiratory failure are at high risk for distress, which is typically defined as the presence of psychological symptoms such as anxiety, depression, or posttraumatic stress. Interventions to reduce caregiver distress and increase wellness have been largely ineffective to date. An incomplete understanding of caregiver wellness and distress may hinder efforts at developing effective support interventions. Objectives: To allow family caregivers to define their experiences of wellness and distress 6 months after patient intensive care unit (ICU) admission and to identify moderators that influence wellness and distress. Methods: Primary family caregivers of adult patients admitted to the medical ICU with acute cardiorespiratory failure were invited to participate in a semistructured interview 6 months after ICU admission as part of a larger prospective cohort study. Interview guides were used to assess caregiver perceptions of their own well-being, record caregiver descriptions of their experiences of family caregiving, and identify key stress events and moderators that influenced well-being during and after the ICU admission. This study was guided by the Chronic Traumatic Stress Framework conceptual model, and data were analyzed using the five-step framework approach. Results: Among 21 interviewees, the mean age was 58 years, 67% were female, and 76% were White. Nearly half of patients (47%) had died before the caregiver interview. At the time of the interview, 9 caregivers endorsed an overall sense of distress, 10 endorsed a sense of wellness, and 2 endorsed a mix of both. Caregivers defined their experiences of wellness and distress as multidimensional and composed of four main elements: 1) positive versus negative physical and psychological outcomes, 2) high versus low capacity for self-care, 3) thriving versus struggling in the caregiving role, and 4) a sense of normalcy versus ongoing life disruption. Postdischarge support from family, friends, and the community at large played a key role in moderating caregiver outcomes. Conclusions: Caregiver wellness and distress are multidimensional and extend beyond the absence or presence of psychological outcomes. Future intervention research should incorporate novel outcome measures that include elements of self-efficacy, preparedness, and adaptation and optimize postdischarge support for family caregivers.
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Affiliation(s)
- Blair Wendlandt
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine
| | | | | | - Bradley N. Gaynes
- Department of Psychiatry, UNC School of Medicine
- Department of Epidemiology, Gillings School of Global Public Health, and
| | - Shannon S. Carson
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine
| | - Laura C. Hanson
- Division of Geriatric Medicine and Palliative Care Program, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Gates MV, Lester EG, Reichman M, Silverman IH, Lin A, Vranceanu AM. Does gender moderate resiliency variables and posttraumatic stress symptoms in informal caregivers of neurocritical care patients? An exploratory study. PSYCHOL HEALTH MED 2024; 29:22-38. [PMID: 36878877 DOI: 10.1080/13548506.2023.2185268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
We examined gender differences between resiliency factors (i.e. mindfulness, self-efficacy, coping, intimate care, and caregiver preparedness) and posttraumatic stress symptoms (PTSS) in informal caregivers of patients in the neuroscience intensive care unit (Neuro-ICU). Ninety-two informal caregivers were enrolled during patients' hospitalization and completed resiliency measures at baseline, and a PTSS measure at baseline, 3 and 6 months. We conducted five ANCOVAs to explore gender and resiliency on PTSS. No significant main effects of gender on PTSS were observed across time points. However, main effects were seen for resiliency on PTSS at baseline for informal caregivers with high (vs. low) mindfulness, coping, and self-efficacy. Gender moderated the association between mindfulness and PTSS (i.e. high mindfulness at baseline was associated with lower PTSS in males compared to females at 3 months) and intimate care and PTSS (high intimate care at baseline was associated with lower PTSS in males than females at 6 months; high intimate care at baseline for females was associated with lower PTSS at 6 months than females with low intimate care). Overall, we observed associations among informal caregivers' gender, resiliency, and PTSS, with males particularly benefitting from mindfulness and intimate care. These findings hold value for future inquiry into gender differences in this population with possible clinical implications.
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Affiliation(s)
- Melissa V Gates
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ethan G Lester
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mira Reichman
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ilyssa H Silverman
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ann Lin
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Albany Medical College, Albany, NY, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Turabi N, Tomar SP, Anyagwa OE, Durganaudu H, Ishwarya V, Kivan H, Kras MM, Samouti P, Khaled E, Ramesh NN, Krishnegowda AS, Shabani MM, Palacios-Garay MA, Ambriz-Salas F, Aigbonoga DE, Bassiony M. Sleep Disturbances among Caregivers of Home-Isolated and Hospitalized COVID-19 Patients: A Multi-National Cross-Sectional Study. Indian J Community Med 2023; 48:676-683. [PMID: 37970177 PMCID: PMC10637614 DOI: 10.4103/ijcm.ijcm_690_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 07/20/2023] [Indexed: 11/17/2023] Open
Abstract
Background Since the coronavirus (COVID-19) pandemic began, several studies were published on the possible prevention and treatment of the disease caused by severe acute respiratory syndrome coronavirus (SARSCoV-2), and its complications. However, one aspect that was overlooked is the impact on the mental health of the caregivers of COVID-19 patients. The current study endeavors to investigate sleep quality disturbances in the caregivers of COVID-19 patients in different countries. Material and Methods This cross-sectional multi-center study was performed between August 1, 2021, and August 30, 2022, across 11 countries. A total of 2411 responses meeting the inclusion criteria (being a family member or caregiver involved in patient care) were collected. The sleep quality was assessed using the self-reported Pittsburgh Sleep Quality Index (PSQI) 12. Total scores ranged from 0 to 21. A ≥5 indicated poor sleep quality with 89.6% sensitivity and 86.5% specificity. Results A total of 2411 responses meeting the inclusion criteria showed that mean PSQI scores (P = 0.3604) were higher in caregivers of hospitalized patients than in patients isolated at home. Approximately 62.4% of caregivers reported sleep quality problems while caring for their patients. Conclusion The results showed that the majority of caregivers of patients with COVID-19 reported disturbances in sleep quality and impaired sleep was more common among caregivers of hospitalized patients, perhaps because hospitalization is associated with a more severe course of the disease. There is a pressing need to take measures to improve the mental health of these caregivers. There should be treatment programs set up to reverse sleep disturbances in this population sufficiently.
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Affiliation(s)
- Nafisa Turabi
- Department of Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | | | | | - Hanusha Durganaudu
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
| | - V Ishwarya
- Department of Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
| | - Husam Kivan
- Faculty of Medicine, OnDokuz Mayıs University, Atakum, Samsun, Turkey
| | - Magdalena M. Kras
- Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
| | - Paraskevi Samouti
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eman Khaled
- School of Medicine, Ankara University, Ankara, Turkey
| | - N Nishitha Ramesh
- Department of Medicine, Father Muller Medical College, Mangalore, Karnataka, India
| | - Amruth S. Krishnegowda
- Department of Medicine, Employees State Insurance Corporation Medical College, Bengaluru, Karnataka, India
| | - Moshi Moshi Shabani
- Department of Orthopaedics and Traumatology, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | | | - Fernanda Ambriz-Salas
- Department of Medicine, Faculty of Medicine, Universidad Justo Sierra, Escuela de Medicina, México
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Watland S, Solberg Nes L, Hanson E, Ekstedt M, Stenberg U, Børøsund E. The Caregiver Pathway, a Model for the Systematic and Individualized Follow-up of Family Caregivers at Intensive Care Units: Development Study. JMIR Form Res 2023; 7:e46299. [PMID: 37097744 PMCID: PMC10170368 DOI: 10.2196/46299] [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: 02/09/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Family caregivers of patients who are critically ill have a high prevalence of short- and long-term symptoms, such as fatigue, anxiety, depression, symptoms of posttraumatic stress, and complicated grief. These adverse consequences following a loved one's admission to an intensive care unit (ICU) are also known as post-intensive care syndrome-family. Approaches such as family-centered care provide recommendations for improving the care of patients and families, but models for family caregiver follow-up are often lacking. OBJECTIVE This study aims to develop a model for structuring and individualizing the follow-up of family caregivers of patients who are critically ill, starting from the patients' ICU admission to after their discharge or death. METHODS The model was developed through a participatory co-design approach using a 2-phased iterative process. First, the preparation phase included a meeting with stakeholders (n=4) for organizational anchoring and planning, a literature search, and interviews with former family caregivers (n=8). In the subsequent development phase, the model was iteratively created through workshops with stakeholders (n=10) and user testing with former family caregivers (n=4) and experienced ICU nurses (n=11). RESULTS The interviews revealed how being present with the patient and receiving adequate information and emotional care were highly important for family caregivers at an ICU. The literature search underlined the overwhelming and uncertain situation for the family caregivers and identified recommendations for follow-up. On the basis of these recommendations and findings from the interviews, workshops, and user testing, The Caregiver Pathway model was developed, encompassing 4 steps: within the first few days of the patient's ICU stay, the family caregivers will be offered to complete a digital assessment tool mapping their needs and challenges, followed by a conversation with an ICU nurse; when the patient leaves the ICU, a card containing information and support will be handed out to the family caregivers; shortly after the ICU stay, family caregivers will be offered a discharge conversation by phone, focusing on how they are doing and whether they have any questions or concerns; and within 3 months after the ICU stay, an individual follow-up conversation will be offered. Family caregivers will be invited to talk about memories from the ICU and reflect upon the ICU stay, and they will also be able to talk about their current situation and receive information about relevant support. CONCLUSIONS This study illustrates how existing evidence and stakeholder input can be combined to create a model for family caregiver follow-up at an ICU. The Caregiver Pathway can help ICU nurses improve family caregiver follow-up and aid in promoting family-centered care, potentially also being transferrable to other types of family caregiver follow-up.
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Affiliation(s)
- Solbjørg Watland
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Medicine Intensive Care Unit, Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Elizabeth Hanson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Frambu Resource Center for Rare Disorders, Ski, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Relationships among Demographic, Clinical, and Psychological Factors Associated with Family Caregiver Readiness to Participate in Intensive Care Unit Care. Ann Am Thorac Soc 2022; 19:1881-1891. [PMID: 35649201 DOI: 10.1513/annalsats.202106-651oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: There has been a paradigm shift to partner with family caregivers by actively involving them in the direct care of the patient throughout the critical illness trajectory. Before effectively engaging family members in patient care, clinicians must assess characteristics and circumstances that may affect caregiver readiness to assume a caregiving role in the intensive care unit (ICU). Objectives: To determine how demographic, clinical, and psychological factors are related to characteristics of family caregiver readiness to engage in ICU patient care. Methods: A convenience sample of ICU family caregivers of both adult and pediatric patients in the ICU was recruited for this cross-sectional study. Participants completed the following measures: PROMIS-29 (Patient-Reported Outcomes Measurement and Information System); HADS (Hospital Anxiety and Depression Scale); CaSES (Caregiver Self-Efficacy Scale); Prep Scale (Preparedness for Caregiving Scale); Patient Activation Measure for Caregivers; and FCMFHS (Family Caregiver's Motives for Helping Scale). Data were collected via self-report at a single time point while the caregiver was visiting the critically ill patient in the ICU. Data analysis consisted of descriptive statistics and bivariate correlations. Results: Caregivers (N = 127) were primarily White (82.7%), females (77.2%), with a mean age of 51.8 (standard deviation [SD], 15.6). Most were either spouses (37.8%) or parents (32.3%) of the patient in the ICU. Patients were primarily adult (76.4%) with a mean APACHE (Acute Physiology, Age, Chronic Health Evaluation) III of 45.9 (SD, 22.5). There were significant (P < 0.05) negative correlations between depression, anxiety, and fatigue and all subscales of self-efficacy (resilience r = -0.18 to -0.30; self-maintenance r = -0.44 to -0.63; emotional connectivity r = -0.27 to -0.41; instrumental giving r = -0.34 to -0.46). Caregiver depression was negatively correlated with caregiver activation (r = -0.199) and caregiver preparedness (r = -0.300). Social satisfaction was positively correlated (P < 0.05) with caregiving preparedness, motivation, and all subscales of self-efficacy (preparedness r = 0.19; motivation r = 0.24; resilience r = 0.21; self-maintenance r = 0.49; emotional connectivity r = 0.29; instrumental giving r = 0.36). Conclusions: We found that caregiver symptoms of depression, anxiety, and fatigue are inversely related to caregiver preparation, motivation, and self-efficacy. To develop effective interventions for ICU family caregivers, further research is needed to understand the relationship between caregiver well-being, caregiving readiness, and caregiver involvement in patient care.
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Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients. Crit Care Explor 2022; 4:e0753. [PMID: 36050994 PMCID: PMC9426807 DOI: 10.1097/cce.0000000000000753] [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: 11/26/2022] Open
Abstract
To determine the degree to which an ICU patient’s family member having an “anxious” psychologic attachment orientation is a risk factor for developing long-term posttraumatic stress disorder (PTSD) symptoms following patient ICU discharge or death.
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Kanmani TR, Raju B, Pallerla S, Mech P, Jacob A, Makkar S. Exploring Psychosocial Concerns and Needs of Ventilator and Nonventilator Caregivers in the Emergency and Trauma Care Setting. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1750182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
Introduction Caregivers of traumatic brain injury (TBI) survivors in ventilators and nonventilator undergo psychological distress and their concerns and needs are secondary to patient care. Thus, this study aimed to explore the day-to-day concerns of the caregivers of ventilator and nonventilator survivors of TBI.
Materials and Methods A descriptive research method with a qualitative and quantitative approach was adopted. Overall, 100 adult caregivers (ventilator care, n = 50), (nonventilator care, n = 50) providing care for patients diagnosed and suffering from TBI were recruited using a cross-sectional survey method. Percentage, mean, standard deviation for continuous variables, and the simple thematic analysis were used for qualitative data.
Results The results showed that mild depression (9.54 ± 3.83) and mild anxiety (9.90 ± 4.22) were present in caregivers who were providing care for ventilator patients. However, no signs of depression (4.78 ± 2.30) and anxiety levels (2.90 ± 2.60) were found in the nonventilator caregivers. The qualitative results showed that social concerns such as marriage, work, psychological worry, and difficulty in decision making were highly present in caregivers.
Conclusion The study findings indicates that psychosocial intervention to be considered as an essential service in the neurotrauma unit to address crisis and support for the caregivers, family members, and patients from the holistic care perspective by medical and psychiatric social workers.
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Affiliation(s)
- Tiruchengode R Kanmani
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Birudu Raju
- Department of Social Work, CMR University, Bengaluru, Karnataka, India
| | - Srikanth Pallerla
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pallavi Mech
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Annmary Jacob
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suffi Makkar
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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O'Gara G, Wiseman T, Doyle AM, Pattison N. Chronic illness and critical care-A qualitative exploration of family experience and need. Nurs Crit Care 2022. [PMID: 35833675 DOI: 10.1111/nicc.12817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with chronic illnesses such as cancer and cardiovascular disease are living longer and often require the support of critical care services. Current health care provision means patients may be discharged home once clinically stable despite still having high care demands including social, emotional, or physical needs. Families are often required to assume caregiving roles. Research into family burden using quantitative methods has increased awareness, however, little qualitative work exists and the development of support interventions for families is required. AIMS To explore the experience and needs of family members of people with an existing chronic illness who are admitted to the Critical Care Unit (CCU), and to identify the desired components of a family support intervention in the form of a resource toolkit. STUDY DESIGN A qualitative exploration of family experience and need, and content development for a resource toolkit using focus group methodology. Two focus groups and one face-to-face interview were conducted involving nine adult (≥18 years) family members of adult patients with chronic illness admitted to critical care in the preceding 9 months across two specialist hospitals in the UK. These were digitally recorded, transcribed, and thematically analysed. FINDINGS Four themes were identified: importance of communication, need for support, trauma of chronic illness, and having to provide "Do-it-Yourself" care. The immense responsibility of families to provide care throughout the illness trajectory is highlighted. Understandable information is essential for a family support toolkit. CONCLUSION Family members often view a critical care episode broadly from diagnosis through to recovery/rehabilitation. Basic communication training skills within critical care should be ensured, alongside coordination of simple solutions. The potential traumatic impact on families should be highlighted early within the pathway, and positive aspects used to harness essential family support. A simple and coordinated approach to a toolkit is preferred. RELEVANCE TO CLINICAL PRACTICE This study highlights that a critical care experience may impact broadly beyond CCU, and the importance of informing patients and families of this potential experience, prior to or on admission, to aid preparation. Further highlighted is the need for contemporaneous and accurate information from clinicians involved in care. Families report a better experience when there is good collaboration across critical care services and admitting clinical teams. Early involvement of families in overall discharge planning is essential to allow patients and families to adjust and plan for recovery.
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Affiliation(s)
- Geraldine O'Gara
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK
| | - Theresa Wiseman
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK
| | - Anne-Marie Doyle
- Department of Psychological Medicine, Royal Brompton Hospital, London, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire/East and North Herts NHS Trust, Hertfordshire, UK
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Akbarbegloo M, Sanaeefar M. Interpreting the Lived Experiences of Home Caregivers in the Families of Patients with Covid-19 in Iran: A Phenomenological Study. Int J Qual Health Care 2022; 34:6504768. [PMID: 35022712 PMCID: PMC8807274 DOI: 10.1093/intqhc/mzab144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/09/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Following the spread of Covid-19, many patients received home care services for recovery. The family is one of the informal caregivers who provide daily physical and psychological support to the patient, and they have the most contributions in the care of patients. Accordingly, this study explains the experiences of home caregivers in the families of patients with Covid-19. Methods This is a qualitative study with a hermeneutic phenomenological approach. Purposeful sampling was applied, and semi-structured interviews in the Center of Covid-19 Control in Khoy, Iran, were used to collect the information. Twenty-three family caregivers, who had already provided care for patients with Covid-19 at home, participated in the study. The themes emerged from interviews. The interviews were recorded and transcripted then analyzed using Dickelman’s interpretive phenomenological approach. Results 13 primary concepts, six sub-themes, and three main themes were extracted from the data analysis, including "Irrational fear of disease" with sub-themes: fear of getting infected and Indulging in strength of immune system, "Increasing the burden of care in caregivers" with sub-themes: lack of support and caregiver`s family challenges and "Self reinforcement" with sub-themes: highlighting positive features and turning to spirituality. Conclusion Understanding the complexities, experiences, and beliefs of family caregivers about living with a Covid-19 patient provides a comprehensive perception of the psychological and physical consequences of care. Executive decision-makers, health care personnel, and mental health professionals can also take the necessary strategies to support and manage home caregivers and interdisciplinary cooperation.
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Affiliation(s)
- Masumeh Akbarbegloo
- Pediatric Nursing Department, Faculty of Nursing, Khoy University of Medical Sciences, Khoy, Iran
| | - Mahnaz Sanaeefar
- Master of Science, Pediatric Nursing Department, Faculty of Nursing, Khoy University of Medical Sciences, Khoy, Iran
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Huang YL, Chen YK, Lin SH, Cao H, Chen Q. The effect of short music videos on needs satisfaction and separation anxiety of children's family members during COVID-19: The example of TikTok. Front Pediatr 2022; 10:990752. [PMID: 36160769 PMCID: PMC9491336 DOI: 10.3389/fped.2022.990752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the effect of short music videos on needs satisfaction and separation anxiety of the family members of children with congenital heart disease (CHD) in the cardiac intensive care unit (CICU) during the COVID-19 pandemic. METHODS Eighty-seven children's family members were divided into the study group and the control group between February 2020 and March 2021. During the COVID-19 pandemic, the participants in the control group were visited by telephone, while the participants in the study group used the TikTok short music video application and WeChat as communication tools. After the intervention, the critical care family needs inventory (CCFNI) and separation anxiety scale (SAS) for all participants were recorded and analyzed. RESULTS There were no statistically significant differences in general characteristics or preintervention data between the two groups. However, the two dimensions of the support scale and information scale of the CCFNI in the study group were significantly different from those in the control group after the intervention (P = 0.008, and P = 0.021, respectively). There were significant differences in the three dimensions of the SAS between the two groups (P = 0.004, P = 0.007, and P = 0.041, respectively). CONCLUSION The visiting system of the ICU changed during the COVID-19 pandemic, and the use of the TikTok short music video application and WeChat was conducive to optimizing the CICU ward visiting process, reducing the separation anxiety of the family members of children in the CICU, and improving their needs satisfaction.
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Affiliation(s)
- Ya-Li Huang
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Yu-Kun Chen
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shi-Hao Lin
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
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12
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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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13
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Experiences of family caregivers of patients with COVID-19. BMC FAMILY PRACTICE 2021; 22:137. [PMID: 34187368 PMCID: PMC8241402 DOI: 10.1186/s12875-021-01489-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/10/2021] [Indexed: 12/23/2022]
Abstract
Background Family caregivers of patients with COVID-19 face many challenges that affect their physical and mental health. Aim The aim of the present study was to explore experiences of family caregivers of patients with COVID-19. Methods This phenomenological study was performed based on 13 family caregivers who had experience in home caring for patients with COVID-19. Data were collected through purposive sampling with in-depth semi-structured interviews. The Colaizzi's 7-step method was used to determine themes. The MAXQDA10 software was used to manage qualitative data analysis. Results Thirteen family caregivers participated. Five main themes describe family caregivers' experiences of caring for patients with COVID-19: nature of the disease; unmet needs; unpleasant physical, psychological, and social experiences; care facilitators and positive experiences. Conclusion Information and financial support for COVID-19 should be provided to family caregivers. Also, community members should embrace patients and family caregivers and reinforce the positive experiences of caregivers. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01489-7.
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14
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Wendlandt B, Chen YT, Lin FC, Toles M, Gaynes B, Hanson L, Carson S. Posttraumatic Stress Disorder Symptom Trajectories in ICU Family Caregivers. Crit Care Explor 2021; 3:e0409. [PMID: 33912839 PMCID: PMC8078333 DOI: 10.1097/cce.0000000000000409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
To use latent class growth analysis to identify posttraumatic stress disorder symptom trajectories in ICU family caregivers. DESIGN Prospective cohort study. SETTING The medical ICU at a tertiary-care center in the United States. PARTICIPANTS Adult patients experiencing acute cardiorespiratory failure (defined as requiring at least one of the following: 1) vasopressors, 2) noninvasive positive pressure ventilation, 3) high-flow nasal cannula, or 4) mechanical ventilation) were enrolled in a pair with their primary family caregivers. MEASUREMENTS AND MAIN RESULTS Participants were enrolled within the first 48 hours of ICU admission. Family caregiver posttraumatic stress disorder symptoms were measured using the Impact of Events Scale-Revised at four time points: at enrollment, shortly after ICU discharge, and at 3 and 6 months after ICU discharge. The data were examined using latent class growth analysis to identify posttraumatic stress disorder symptom trajectories. Two distinct symptom trajectories were identified: a persistently high trajectory, characterized by high posttraumatic stress disorder symptoms at initial assessment, which remained elevated over time, and a persistently low trajectory, characterized by low posttraumatic stress disorder symptoms at initial assessment, which remained low over time. Approximately two-thirds of caregivers belonged to the persistently high trajectory, and one-third of caregivers belonged to the persistently low trajectory. CONCLUSIONS Using latent class growth analysis to measure 6-month ICU family caregiver posttraumatic stress disorder symptom trajectories, we identified two distinct trajectories (persistently low and persistently high). A larger cohort study is warranted to further delineate posttraumatic stress disorder trajectories in this population, with the ultimate goal of targeting high-risk caregivers for interventions to reduce psychologic distress and improve long-term caregiver outcomes.
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Affiliation(s)
- Blair Wendlandt
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Yi Tang Chen
- College of Public Health, The Ohio State University, Columbus, OH
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Mark Toles
- University of North Carolina School of Nursing, Chapel Hill, NC
| | - Bradley Gaynes
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Laura Hanson
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Shannon Carson
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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15
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Saeid Y, Salaree MM, Ebadi A, Moradian ST. Family Intensive Care Unit Syndrome: An Integrative Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:361-368. [PMID: 33344205 PMCID: PMC7737832 DOI: 10.4103/ijnmr.ijnmr_243_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022]
Abstract
Background: Hospitalization in the Intensive Care Unit (ICU) brings about psychological and physical symptoms in patients' family members. Family Intensive Care Unit Syndrome (FICUS) is a term used to explain the psychological symptoms of the family of a patient in response to the patient's admission to the ICU. The purpose of this study was to define FICUS along with its symptoms and predictors. Materials and Methods: The Web of Science, PubMed, Scopus, Google Scholar, and SID databases were searched for literature published in 2005–2018 with the keywords “FICUS,” “intensive care unit,” “family,” “caregivers,” “anxiety,” “depression,” and “post-traumatic stress disorder” in their title and abstract. The strategy for conducting an integrative review provided by Whittemore and Knafl (2005) was used in this study. Results: Twenty articles were included in the final data analysis. Following the patient's admission to the ICU, family members experience multiple psychological symptoms such as FICUS. The most commonly reported symptoms were anxiety, depression, post-traumatic stress disorder (PTSD), complicated grief, sleep disorder, stress, and fatigue. The low education level, having a critically-ill spouse, adequate support, financial stability, preference for decision-making, understanding of the disease process, anxiety, depression, or previous acute stress were predictors of FICUS. Conclusions: On the basis of the results, families also experience physical symptoms, so the FICUS is not limited to the occurrence of psychological symptoms. This study found that there is no universal definition for the term “FICUS” in the research literature. Thus, further research is needed to explore FICUS in the health field.
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Affiliation(s)
- Yaser Saeid
- Students Research Committee and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Salaree
- Health Research Center. Life style institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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16
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Zucato da Silva C, José Gomes Campos C, Ferraz Martins Jamarim M, Marcondes pimentel de abreu lima G. Experiencias de pacientes con discapacidades funcionales posteriores al tratamiento en la Unidad de Cuidados Intensivos. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Comprender las experiencias de los pacientes con discapacidades funcionales después del tratamiento en la Unidad de Cuidados Intensivos a su regreso a casa. Materiales y métodos: Se trata de un estudio de enfoque cualitativo que utilizó el estudio de caso como método de investigación. La muestra de ocho participantes fue compuesta intencionalmente y cerrada por saturación teórica. La recolección de datos se realizó a través de entrevistas domiciliarias semiestructuradas complementadas con notas y diarios de campo. Los datos fueron analizados mediante el análisis de contenido temático propuesto por Minayo. Resultados: La atención primaria, a través de la atención domiciliaria, fue la principal responsable del seguimiento posterior al alta de los participantes. Del material empírico, surgieron las categorías "sufrimiento emocional y sus repercusiones en la recuperación funcional" y "la pérdida del rol familiar y los conflictos con los cuidadores". Discusión y conclusiones: La recuperación funcional de pacientes con discapacidades funcionales después de pasar por cuidados intensivos puede ser compleja y requiere, además de rehabilitación física, monitoreo psicoemocional adecuado, aclaración de los recuerdos de hospitalización y apoyo profesional a la familia. Se sugiere que la atención primaria reciba capacitación sobre la complejidad de estos pacientes y la creación de estrategias que lo acerquen a la atención hospitalaria, lo que permite una atención compartida y continua.
Como citar este artículo: Silva, Camila Zucato; Campos, Claudinei José Gomes; Jamarim, Michelle Ferraz Martins; Lima, Gerusa Marcondes Pimentel de Abreu. Vivências de pacientes diante de incapacidades funcionais pós-tratamento em Unidade de Terapia Intensiva. Revista Cuidarte. 2020; 11(2): e1018. http://dx.doi.org/10.15649/cuidarte.1018
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17
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LaBuzetta JN, Rosand J, Vranceanu AM. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. Neurocrit Care 2019; 31:534-545. [PMID: 31486026 PMCID: PMC7007600 DOI: 10.1007/s12028-019-00826-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California-San Diego, 9444 Medical Center Drive, ECOB 3-028, MC 7740, La Jolla, CA, 92037, USA.
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ana-Maria Vranceanu
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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18
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Quality of Life and Related Factors Among Patients Discharged from Critical Care Units. ACTA ACUST UNITED AC 2017. [DOI: 10.5812/ccn.62148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Frivold G, Slettebø Å, Heyland DK, Dale B. Family members' satisfaction with care and decision-making in intensive care units and post-stay follow-up needs-a cross-sectional survey study. Nurs Open 2017; 5:6-14. [PMID: 29344389 PMCID: PMC5762765 DOI: 10.1002/nop2.97] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
Aim The aim of this study was to explore family members' satisfaction with care and decision‐making during the intensive care units stay and their follow‐up needs after the patient's discharge or death. Design A cross‐sectional survey study was conducted. Methods Family members of patients recently treated in an ICU were participating. The questionnaire contented of background variables, the instrument Family Satisfaction in ICU (FS‐ICU 24) and questions about follow‐up needs. Descriptive and non‐parametric statistics and a multiple linear regression were used in the analysis. Results A total of 123 (47%) relatives returned the questionnaire. Satisfaction with care was higher scored than satisfaction with decision‐making. Follow‐ up needs after the ICU stay was reported by 19 (17%) of the participants. Gender and length of the ICU stay were shown as factors identified to predict follow‐up needs.
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Affiliation(s)
- Gro Frivold
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Åshild Slettebø
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Daren K Heyland
- Clinical Evaluation Research Unit Kingston General Hospital Kingston ON Canada.,The Canadian Researchers at the End of Life Network Kingston ON Canada.,Critical Care Nutrition Department of Critical Care Medicine Queen's University Kingston ON Canada
| | - Bjørg Dale
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway.,Centre for Caring Research Southern Norway Grimstad Norway
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