Nursing strategies to support family members of ICU patients at high risk of dying

Abstract Background/Objective Death in intensive care units (ICUs) may increase bereaved family members’ risk for posttraumatic stress disorder (PTSD). However, posttraumatic stress-related symptoms (hereafter as PTSD symptoms) and their precipitating factors were seldom examined among bereaved family members and primarily focused on associations between PTSD symptoms and patient/family characteristics. We aimed to investigate the course and predictors of clinically significant PTSD symptoms among family members of deceased ICU patients by focusing on modifiable quality indicators for end-of-life ICU care. Method In this longitudinal observational study, 319 family members of deceased ICU patients were consecutively recruited from medical ICUs from two Taiwanese medical centers. PTSD symptoms were assessed at 1, 3, 6, and 13 months post-loss using the Impact of Event Scale-Revised (IES-R). Family satisfaction with end-of-life care in ICUs was assessed at 1 month post-loss. End-of-life care received in ICUs was documented over the patient’s ICU stay. Predictors for developing clinically significant PTSD symptoms (IES-R score ≥ 33) were identified by multivariate logistic regression with generalized estimating equation modeling. Results The prevalence of clinically significant PTSD symptoms decreased significantly over time (from 11.0% at 1 month to 1.6% at 13 months post-loss). Longer ICU stays (adjusted odds ratio [95% confidence interval] = 1.036 [1.006, 1.066]), financial insufficiency (3.166 [1.159, 8.647]), and reported use of pain medications (3.408 [1.230, 9.441]) by family members were associated with a higher likelihood of clinically significant PTSD symptoms among family members during bereavement. Stronger perceived social support (0.937 [0.911, 0.965]) and having a Do-Not-Resuscitate (DNR) order issued before the patient’s death (0.073 [0.011, 0.490]) were associated with a lower likelihood of clinically significant PTSD symptoms. No significant association was observed for family members’ satisfaction with end-of-life care (0.988 [0.944, 1.034]) or decision-making in ICUs (0.980 [0.944, 1.018]). Conclusions The likelihood of clinically significant PTSD symptoms among family members decreased significantly over the first bereavement year and was lower when a DNR order was issued before death. Enhancing social support and facilitating a DNR order may reduce the trauma of ICU death of a beloved for family members at risk for developing clinically significant PTSD symptoms.

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Cascade screening for glaucoma in high-risk family members of African-Caribbean glaucoma patients in an urban population in London

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317373 ◽

2020 ◽

pp. bjophthalmol-2020-317373

Author(s):

Anindyt Nagar ◽

Sam Myers ◽

Diana Kozareva ◽

Mark Simcoe ◽

Christopher Hammond

Keyword(s):

High Risk ◽

Genetic Diseases ◽

Family Doctor ◽

Family Members ◽

Hospital Setting ◽

High Risk Group ◽

Cascade Screening ◽

Specialist Referral ◽

High Risk Family ◽

African Caribbean

Background/aimsCascade screening has been used successfully in relatives of patients with inherited cancers and other genetic diseases to identify presymptomatic disease. This study was designed to examine if this approach would be successful in a high-risk group: first-degree relatives (FDR) of African-Caribbean glaucoma patients resident in London.MethodsAfrican-Caribbean patients (probands) with glaucoma from an inner London hospital setting in a deprived area were asked to disseminate personalised information to their FDR over the age of 30 and to arrange a free hospital-based screening. Data collected, including optical coherence tomography imaging, were reviewed by a glaucoma specialist and if glaucoma was diagnosed or suspected, local specialist referral via family doctor was made.Results203 probands were recruited from glaucoma clinics. 248 suitable FDR were identified as potentially eligible to attend screening. 57 (23%) FDR made contact with the research team of whom 18 (7%) attended a subsequent screening visit. No patients were diagnosed with glaucoma; one participant was diagnosed as glaucoma suspect. Reasons for poor uptake included reluctance by probands to involve their family members, and retirees spending significant time abroad.ConclusionCascade screening of FDR of African-Caribbean glaucoma patients in inner city London was unsuccessful. Research confidentiality guidance prohibiting research teams directly contacting family members was a barrier. Greater community engagement, community-based screening and permission to contact FDR directly might have improved uptake.

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Percutaneous dilatational tracheotomy in high-risk ICU patients

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.152 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

E Luesebrink ◽

S Massberg ◽

M Orban

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

High Risk ◽

Triple Therapy ◽

Bleeding Risk ◽

Icu Patients ◽

Procedural Complications ◽

Multivariable Regression ◽

International Multicenter Study ◽

International Multicenter

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous dilatational tracheotomy (PDT) has become an established procedure in cardiac intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. There is a need for critical evaluation of these safety concerns. This is the first and largest international, multicenter study on PDT to date including such a high proportion of patients on antithrombotic therapy investigating whether PDT in high-risk ICU patients is associated with elevated procedural complications and analysing risk factors for bleeding occurring during and after PDT. Methods PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed. Procedure-related complications for each risk group were analysed until hospital discharge. Additionally, predictors of bleeding occurrence were analysed by uni- and multivariable regression models. Results In total, 671 patients receiving PDT according to Ciaglia’s technique with accompanying bronchoscopy were included. Patients were stratified into seven clinically relevant antithrombotic treatment groups. Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related, none of which required surgical intervention. In almost all cases bleedings were associated with skin bleedings from the entry site and could easily be treated with minimally invasive stitching. Subgroup analysis showed no increase in the rate of procedure-related complications in patients with elevated body mass index. In a multivariable regression model bleeding occurrence during and after PDT was independently associated with platelet count (Odds ratio [OR] 0.73, 95% confidence interval [95% CI] [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). Neither PTT (OR 1.01, 95% CI [0.99, 1.02], p = 0.32), nor DAPT (OR 1.11, 95% CI [0.56, 2.04], p = 0.75) nor triple therapy (OR 0.93, 95% CI [0.49, 1.66], p = 0.82) were associated with bleeding risk. Conclusion In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT whereas DAPT and triple therapy had no influence on bleeding events.

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Ethical Issues Surrounding High-Risk Kidney Recipients: Implications for the Living Donor

Progress in Transplantation ◽

10.1177/152692480701700304 ◽

2007 ◽

Vol 17 (3) ◽

pp. 180-182 ◽

Cited By ~ 3

Author(s):

Jerome F. O'Hara ◽

Katrina Bramstedt ◽

Stewart Flechner ◽

David Goldfarb

Keyword(s):

Informed Consent ◽

High Risk ◽

Ethical Issues ◽

Family Members ◽

Transplant Recipients ◽

Kidney Donor ◽

Living Kidney Donor ◽

Kidney Recipients ◽

Medical Issues ◽

Donor Transplant

Evaulating patients for living kidney donor transplantation involving a recipient with significant medical issues can create an ethical debate about whether to proceed with surgery. Donors must be informed of the surgical risk to proceed with donating a kidney and their decision must be a voluntary one. A detailed informed consent should be obtained from high-risk living kidney donor transplant recipients as well as donors and family members after the high perioperative risk potential has been explained to them. In addition, family members need to be informed of and acknowledge that a living kidney donor transplant recipient with pretransplant extrarenal morbidity has a higher risk of a serious adverse outcome event such as graft failure or recipient death. We review 2 cases involving living kidney donor transplant recipients with significant comorbidity and discuss ethical considerations, donor risk, and the need for an extended informed consent.

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How to … support family members at the end of life

Nursing and Residential Care ◽

10.12968/nrec.2018.20.1.56 ◽

2018 ◽

Vol 20 (1) ◽

pp. 56-56 ◽

Cited By ~ 1

Author(s):

Adrian Ashurst

Keyword(s):

End Of Life ◽

Family Members ◽

Support Family

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Functional outcomes in high risk ICU patients in Central Australia: a prospective case series

Rural and Remote Health ◽

10.22605/rrh2128 ◽

2013 ◽

Author(s):

Paul Secombe ◽

Penelope Stewart ◽

Alex Brown

Keyword(s):

High Risk ◽

Functional Outcomes ◽

Case Series ◽

Icu Patients ◽

Central Australia ◽

Prospective Case Series

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A Qualitative Study on Emergency Healthcare Worker (EHCW) Perception towards COVID-ACLS Simulation Training in Resuscitating Suspected COVID-19 Patients

Sains Malaysiana ◽

10.17576/jsm-2021-5009-27 ◽

2021 ◽

Vol 50 (9) ◽

pp. 2847-2858

Author(s):

Jebby Yii ◽

Alias Mahmud ◽

Azlan Helmy Abd Samat ◽

Dazlin Masdiana Sabardin ◽

Mohd Hisham Mohd Isa ◽

...

Keyword(s):

High Risk ◽

Group Discussion ◽

Family Members ◽

Safety Issues ◽

High Risk Patients ◽

Resuscitation Training ◽

New Knowledge ◽

Risk Patients ◽

Protective Methods ◽

Regular Training

The emergence of COVID-19 pandemic has caused difficulty to emergency-HCW (EHCW) in resuscitating high-risk patients. We set out to explore EHCW’s perception after undergoing COVID-ACLS resuscitation training and address their anxiety of working in this pandemic. A qualitative case study using focused group discussion was conducted among EHCW who have undergone COVID-ACLS training. Five semi-structured questions exploring respondent’s confidence level, anxiety factors, areas of improvement for COVID-ACLS and if this COVID-ACLS training is sufficient. Inductive and deductive thematic analysis approach was done to analyse the result. 20 EHCW participated in this study. Out of 4 themes, 11 subthemes were identified based on the respondents. They were acquired new knowledge, self-precaution, method of delivery, concerns of self and family members, stigmatisation, insufficient protective methods, underappreciation, regular training sessions, other modalities for learning, course duration; and unsatisfactory reading material. New knowledge and self-precaution were noted to be an important aspect that boosts confidence among EHCW. The main factor that increased anxiety was safety issues and disease spreading to family members, colleagues, and society. In conclusion, COVID-ACLS training is able to boost EHCW confidence in resuscitating high-risk patients. Factors leading to anxiety among EHCW should also be addressed during this pandemic to ensure psychological welfare and mental health are not affected. Regular training and utilisation of other teaching modalities such as video are perceived as a helpful adjunct in boosting their confidence. The utilisation of new training approach should be explored in enhancing EHCW’s knowledge and confidence.

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Pengalaman Keluarga Dalam Memberikan Dukungan Terhadap Penderita Hipertensi

JURNAL KEBIDANAN ◽

10.35890/jkdh.v10i1.168 ◽

2021 ◽

Vol 10 (1) ◽

pp. 24-30

Author(s):

Rusdianingseh

Keyword(s):

Family Support ◽

Financial Support ◽

Family Members ◽

Family Participation ◽

Design Data ◽

Descriptive Phenomenology ◽

Family Expectations ◽

Open Code ◽

Depth Interviews ◽

Support Family

Hipertensi termasuk salah satu penyakit degenaratif yang sering dijumpai di masyarakat dan sering muncul tanpa gejala. Penyakit hipertensi akan menjadi masalah yang serius jika tidak dikelola dengan baik, karena akan berkembang dan menimbulkan komplikasi yang berbahaya. Keberhasilan pengendalian hipertensi, salah satunya dipengaruhi oleh dukungan keluarga. Dukungan keluarga merupakan bentuk interaksi antar anggota keluarga yang dapat memberikan kenyamanan fisik dan psikologis. Tujuan penelitian ini adalah untuk mendapatkan pemahaman mendalam mengenai arti dan makna dukungan keluarga terhadap penderita hipertensi. Penelitian ini menggunakan desain fenomenologi deskriptif. Pengumpulan data dilakukan dengan wawancara mendalam. Partisipan dalam penelitian ini adalah keluarga yang mempunyai anggota keluarga menderita hipertensi yang tinggal di wilayah Kebonsari Surabaya. Data yang dikumpulkan adalah rekaman wawancara yang dibuat transkrip verbatim serta dianalisa menggunakan aplikasi Open Code 4.0. Hasil penelitian ini adalah teridentifikasi 4 tema yaitu Respon psikologis emosional, Dukungan finansial, Dukungan instrumen dan Harapan keluarga. Peningkatan pengetahuan dan peran serta keluarga sangat diperlukan untuk penderita hipertensi dalam mengendalikan tekanan darah ABSTRACT Hypertension is a degenerative disease that is often found in society and often appears without symptoms. Hypertension will become a serious problem if it is not managed properly, because it will develop and cause dangerous complications. The successfull of controlling hypertension is influenced by family support. Family support is a form of interaction between family members that can provide physical and psychological comfort. The purpose of this study was to gain an in-depth understanding of the meaning and meaning of family support for hypertensive sufferers. This study used a descriptive phenomenology design. Data collection was carried out by in-depth interviews. Participants in this study are families who have family members suffering from hypertension who live in the Kebonsari area of Surabaya. The data collected were recorded interviews made with verbatim transcripts and analyzed using the Open Code 4.0 application. The results of this study identified 4 themes, namely emotional psychological response, financial support, instrument support and family expectations. Increased knowledge and family participation is needed for people with hypertension in controlling blood pressure.

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Social Support and Nonsuicidal Self-injury among Adolescent Psychiatric Inpatients

10.31234/osf.io/kvb73 ◽

2021 ◽

Author(s):

John K. Kellerman ◽

Alexander Millner ◽

Victoria W. Joyce ◽

Carol C. Nash ◽

Ralph Buonopane ◽

...

Keyword(s):

Social Support ◽

High Risk ◽

Clinical Sample ◽

Family Members ◽

Protective Effects ◽

Multiple Sources ◽

Cross Sectional ◽

Self Injury ◽

Sources Of Support ◽

Nonsuicidal Self Injury

Objective: Cross-sectional studies and prospective studies with long follow-up periods (e.g., years) have shown that lower levels of social support are associated with nonsuicidal self-injury (NSSI) among adolescents. This study examined how short-term changes in social support may contribute to NSSI behavior and whether different sources of support (e.g., friends, family members) provide differential protective effects against NSSI. Methods: We examined fluctuations in NSSI and social support perceived from multiple sources among a sample of 118 high-risk adolescents hospitalized for serious self-harm risk. Participants provided daily reports of social support and any self-injurious behavior for the duration of their inpatient treatment (721 total observations, average observations per participant = 6.11). Multi-level models were used to assess variability in social support and how these fluctuations relate to whether or not an individual engages in NSSI. Results: Over one-third of participants reported engaging in NSSI at least once during inpatient hospitalization and self-reported social support varied considerably within-person across sources of support. Support perceived from family members and inpatient unit staff was inversely associated with NSSI, but no relationship was found between NSSI and support from other patients on the unit or friends outside of the unit. Conclusions: These findings suggest that the protective effects of social support for NSSI vary over short periods of time and that support perceived from adults is particularly relevant among this high-risk clinical sample. This study represents an important step in identifying risk factors to improve the detection and prevention of NSSI among adolescent inpatients.

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