Effects of ICU Patients’ Advanced Directives on Stress Levels in Family Members

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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Delivering Cognitive Behavioral Therapy for Post–Intensive Care Syndrome–Family via a Mobile Health App

American Journal of Critical Care ◽

10.4037/ajcc2021962 ◽

2021 ◽

Vol 30 (6) ◽

pp. 451-458

Author(s):

Amy Petrinec ◽

Cindy Wilk ◽

Joel W. Hughes ◽

Melissa D. Zullo ◽

Yea-Jyh Chen ◽

...

Keyword(s):

Intensive Care ◽

Cognitive Behavioral Therapy ◽

Mobile Health ◽

Behavioral Therapy ◽

Family Members ◽

Intervention Group ◽

Cognitive Behavioral ◽

Control Group ◽

Icu Patients ◽

Post Intensive Care Syndrome

Background Family members of intensive care unit (ICU) patients are at risk for post–intensive care syndrome– family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. Objectives To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. Methods This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. Results The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. Conclusions The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.

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Anxiety and depression symptoms in family members of icu patients

Avances en Enfermería ◽

10.15446/av.enferm.v33n1.48670 ◽

2015 ◽

Vol 33 (1) ◽

pp. 47-54 ◽

Cited By ~ 5

Author(s):

Maria Kourti ◽

Efstathia Christofilou ◽

George Kallergis

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Demographic Data ◽

Family Members ◽

Depression Scale ◽

Self Report ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Hospital Anxiety ◽

Icu Patients

Objective: This study investigated symptoms of anxiety and depression in relatives of patients admitted in the Intensive Care Unit and determined whether these symptoms were associated to the seriousness of the patients’ condition.Metodology: A total of 102 patients’ relatives were surveyed during the study. They were given a self-report questionnaire in order to assess demographic data, anxiety and depression symptoms. The symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (hads). Patient’s condition was evaluated with a.p.a.ch.e ii Score.Results: More than 60% of patients’ relatives presented severe symptoms of anxiety and depression. No relation was found between symptoms of anxiety and depression of the relatives of patients and patients’ condition of health. On the contrary, these feelings used to exist regardless of the seriousness of patient’s condition.Conclusions: The assessment of these patients is recommended in order serious problems of anxiety and depression to be prevented.

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

Heart & Lung ◽

10.1016/j.hrtlng.2014.02.001 ◽

2014 ◽

Vol 43 (5) ◽

pp. 406-415 ◽

Cited By ~ 40

Author(s):

Judith A. Adams ◽

Ruth A. Anderson ◽

Sharron L. Docherty ◽

James A. Tulsky ◽

Karen E. Steinhauser ◽

...

Keyword(s):

High Risk ◽

Family Members ◽

Icu Patients ◽

Support Family

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Improving partnerships with family members of ICU patients: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-017-2379-4 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 7

Author(s):

Daren K. Heyland ◽

Judy Davidson ◽

Yoanna Skrobik ◽

Amanda Roze des Ordons ◽

Lauren J. Van Scoy ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Study Protocol ◽

Controlled Trial ◽

Family Members ◽

Icu Patients ◽

Randomized Controlled

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P02.186 Anxiety and depression in family members of ICU patients: Ethical considerations regarding decision-making capacity

European Psychiatry ◽

10.1016/s0924-9338(00)94594-2 ◽

2000 ◽

Vol 15 (S2) ◽

pp. 372s-372s

Author(s):

F. Pochard ◽

E. Azoulay ◽

S. Chevret ◽

I. Ferrand ◽

J.F Dhainaut ◽

...

Keyword(s):

Decision Making ◽

Family Members ◽

Anxiety And Depression ◽

Ethical Considerations ◽

Icu Patients ◽

Decision Making Capacity

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Effectiveness of self instructional Module on Perception of Needs among Family Members of ICU patients

International Journal of Advances in Nursing Management ◽

10.5958/2454-2652.2016.00086.x ◽

2016 ◽

Vol 4 (4) ◽

pp. 388

Author(s):

M.G. Manoj

Keyword(s):

Family Members ◽

Icu Patients ◽

Instructional Module

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Leadership Behaviors for Facilitating Adaptive Work of Family Members of Seriously Ill ICU Patients (S701)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2014.11.182 ◽

2015 ◽

Vol 49 (2) ◽

pp. 407

Author(s):

Judith Adams ◽

Sharron Docherty ◽

James Tulsky ◽

Karen Steinhauser ◽

Donald Bailey

Keyword(s):

Leadership Behaviors ◽

Family Members ◽

Icu Patients ◽

Adaptive Work ◽

Seriously Ill

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MONITOR-IC study, a mixed methods prospective multicentre controlled cohort study assessing 5-year outcomes of ICU survivors and related healthcare costs: a study protocol

BMJ Open ◽

10.1136/bmjopen-2017-018006 ◽

2017 ◽

Vol 7 (11) ◽

pp. e018006 ◽

Cited By ~ 5

Author(s):

Wytske Geense ◽

Marieke Zegers ◽

Hester Vermeulen ◽

Mark van den Boogaard ◽

Johannes van der Hoeven

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Mixed Methods ◽

Healthcare Costs ◽

Family Members ◽

Support Needs ◽

Icu Patients ◽

Care And Support ◽

Long Term Consequences

IntroductionDue to advances in critical care medicine, more patients survive their critical illness. However, intensive care unit (ICU) survivors often experience long-term physical, cognitive and mental problems, summarised as post-intensive care syndrome (PICS), impacting their health-related quality of life (HRQoL). In what frequency PICS occurs, and to what extent this influences ICU survivors’ HRQoL, is mostly unknown. The aims of this study are therefore to study the: (1) 5-year patient outcomes, (2) predictors for PICS, (3) ratio between HRQoL of ICU survivors and healthcare-related costs, and (4) care and support needs.MethodsThe MONITOR-IC study is a multicentre prospective controlled cohort study, carried out in ICUs in four Dutch hospitals. Patients will be included between July 2016 and July 2021 and followed for 5 years. We estimated to include 12000 ICU patients. Outcomes are the HRQoL, physical, cognitive and mental symptoms, ICU survivors’ care and support needs, healthcare use and related costs. A control cohort of otherwise seriously ill patients will be assembled to compare long-term patient-reported outcomes. We will use a mixed methods design, including questionnaires, medical data from patient records, cost data from health insurance companies and interviews with patients and family members.Ethics and disseminationInsights from this study will be used to inform ICU patients and their family members about long-term consequences of ICU care, and to develop prediction and screening instruments to detect patients at risk for PICS. Subsequently, tailored interventions can be developed and implemented to prevent and mitigate long-term consequences. Additionally, insights into the ratio between HRQoL of ICU patients and related healthcare costs during 5 years after ICU admission can be used to discuss the added value of ICU care from a community perspective. The study has been approved by the research ethics committee of the Radboud University Medical Center (2016-2724).Clinical trial registrationNCT03246334

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Stressors and level of stress among different nursing positions and the associations with hyperlipidemia, hyperglycemia, and hypertension: a national questionnaire survey

BMC Nursing ◽

10.1186/s12912-021-00777-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Po-Ya Chang ◽

Shu-Ti Chiou ◽

Wen-Yen Lo ◽

Nicole Huang ◽

Li-Yin Chien

Keyword(s):

Body Mass Index ◽

Registered Nurses ◽

Job Stress ◽

Body Mass ◽

Nurse Practitioners ◽

Stress Level ◽

Family Members ◽

Working Hours ◽

Job Stressors ◽

Stress Levels

Abstract Background Nurses are faced with varying job stressors depending on their positions and duties. Few previous studies have compared job stress and related chronic conditions among different nursing positions. The objectives were to compare job stressors among clinical registered nurses, nurse practitioners, and head nurses and explore the impact of job stressors and stress level on hyperlipidemia, hyperglycemia, and hypertension. Methods Secondary data extracted from a survey of health-care workers conducted from May to July 2014 across 113 hospitals in Taiwan was used. This analysis included 17,152 clinical registered nurses, 1438 nurse practitioners, and 2406 head nurses. Socio-demographic characteristics, job stressors, stress levels, and hyperlipidemia, hyperglycemia, and hypertension variables were extracted. Results Perceived stressors differed among clinical registered nurses, nurse practitioners, and head nurses, but overall stress level did not. Nurse practitioners and head nurses showed significantly higher prevalence of hyperlipidemia, hyperglycemia, and hypertension than clinical registered nurses. Higher stress levels, age, body mass index, work hours, and caring for family members were positively associated with hyperlipidemia, hyperglycemia, and hypertension. After adjustment for these variables, risk of hyperlipidemia, hyperglycemia, and hypertension did not differ across the nursing positions. Conclusions Although stressors vary by different nursing positions, overall stress level does not. Hyperlipidemia, hyperglycemia, and hypertension are related to stress level, age, body mass index, weekly working hours, and caring for family members. Hence, alleviating job stress and avoiding long working hours are likely to reduce the risk of hyperlipidemia, hyperglycemia, and hypertension in nurses.

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