scholarly journals Impact of Chronic Critical Illness on the Psychological Outcomes of Family Members

2010 ◽  
Vol 21 (1) ◽  
pp. 80-91
Author(s):  
Ronald L. Hickman ◽  
Sara L. Douglas

The uncertain trajectory of chronic critical illness exposes the patient’s family to heightened levels of psychological distress. Symptoms of psychological distress affect more than half of family members exposed to the patient’s chronic critical illness. Although symptoms often dissipate over time, a significant proportion of family members will remain at moderate to high risk for psychological distress well after the patient’s death or discharge from the intensive care unit. Family members of chronically critically ill patients are often involved in the decision making for the patients. Irrational or uninformed decision making can occur when family members experience high levels of psychological distress. Attention to the psychological needs and provision of support to family members enhance the formulation of treatment decisions consistent with the patient’s preferences and mitigate unnecessary resource use. In this article, the impact of chronic critical illness on family members’ risk for depression, anxiety, and posttraumatic stress disorder is described and a review of evidence-based strategies to support the psychological needs of family members coping with a patient’s chronic critical illness is provided.

2021 ◽  
Vol 129 ◽  
pp. 02010
Author(s):  
Renata Legenzova ◽  
Gintarė Leckė

Research background: Globalization, digitalization and growth of technological innovations trigger development of new financial services, such as real estate crowdfunding. Seeking better return opportunities individual investors often disregard neoclassical decision-making criteria, while behavioral factors, such as social influence, emotions, cognitive abilities are gaining importance. This paper addresses the role of family economics socialization as a complex process by which individuals acquire social skills, knowledge, behavior patterns needed to make investment decision by purposively or spontaneously interacting with their family members. Purpose of the article is to assess if and how family economic socialization impacts on investor behavior in real estate crowdfunding. Methods: Research data was collected through an online survey of Lithuanian real estate crowdfunding investors. Then structural equation modeling technique was employed to investigate the impact of family economic socialization on behavior of real estate crowdfunding investors. Findings & Value added: Findings revealed that majority of real estate crowdfunding investors make bounded rationality investment decisions. Family, as one of the main agents of the economic socialization, does not ensure rationality of the crowdfunding decision-making process. Purposive family economic socialization has no impact on the behavior of investors with bounded rationality, yet it has a significant impact on behavior of rational family members. Spontaneous family economic socialization proved to have a positive and significant impact on the behavior of investors with bounded rationality. Taking into consideration rapid global development of innovative financial services market, such results might be a troubling signal for the product developers and market regulators.


2010 ◽  
Vol 21 (1) ◽  
pp. 44-61 ◽  
Author(s):  
Clareen Wiencek ◽  
Chris Winkelman

The syndrome of chronic critical illness has well-documented emotional, social, and financial burdens for individuals, caregivers, and the health care system. The purpose of this article is to provide experienced acute and critical care clinicians with essential information about the prevalence and profile of the chronically critically ill patient needed for comprehensive care. In addition, pathophysiology contributing to chronic critical illness is addressed, though the exact mechanism underlying the conversion of acute critical illness to chronic critical illness is unknown. Clinicians can use this information to identify at-risk intensive care unit patients and to institute proactive care to minimize burden and distress experienced by patients and their caregivers.


Author(s):  
Claire Colebourn ◽  
Jim Newton

This chapter describes the pathophysiology and methods of assessment of valve lesions affecting the aortic and mitral valves. It describes the management of these valve lesions in the critical care setting and guides decision-making about the impact of the valve lesion on the critical illness. The diagnosis and management of infective endocarditis are described in detail.


1996 ◽  
Vol 42 (1) ◽  
pp. 43-63 ◽  
Author(s):  
S. Sörensen ◽  
S. H. Zarit

The impact of providing care to the frail elderly on individual caregivers and their families has been discussed at length, but few researchers have investigated (he events and circumstances preceding the onset of caregiving. In addition, although there is evidence that several family members are usually involved in planning and decision making about caregiving, the majority of studies in this area include only one generation. Based on a larger theoretical framework of preparation for caregiving [1, 2], the extent to which family members anticipate and plan for future caregiving is investigated. In addition, the extent to which they are satisfied with these preparations is studied. Interviews were conducted with mothers, daughters, and granddaughters in thirty-three multigeneration families. While substantial numbers of both mothers and daughters anticipated the need for care for the oldest generation, few made concrete plans about how to organize future care provision. Planners were more satisfied with the amount of discussion and planning in their family than non-planners. Implications for future research and practice applications are discussed.


Author(s):  
Catherine L. Hough

Chronic critical illness (CCI) is common and describes a state of prolonged critical illness, in which patients have persisting organ failures requiring treatment in an intensive care setting. There are many different definitions of CCI, with most including prolonged (> 96 hours) mechanical ventilation. Advanced age, higher severity of illness, and poor functional status prior to critical illness are all important risk factors, but prediction of CCI is imperfect. Although requirement for mechanical ventilation is the hallmark, CCI encompasses much more than the respiratory system, with effects on metabolism, skin, brain, and neuromuscular function. During CCI, patients have a high burden of symptoms and impaired capacity to communicate their needs. Mortality and quality of life are generally poor, but highly variable, with 1-year mortality over 50% and most survivors suffering permanent cognitive impairment and functional dependence. Patients at highest and lowest risk for mortality can be identified using a simple prediction rule. Caring for the chronically critically ill is a substantial burden both to patients’ families and to the health care system as a whole. Further research is needed in order to improve care and outcomes for CCI patients and their families.


2015 ◽  
Vol 20 (4) ◽  
pp. 232-241 ◽  
Author(s):  
Eleanor Bradley

Purpose – The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design/methodology/approach – The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings – Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research limitations/implications – Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical implications – Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the “triangle of care” with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social implications – The families of people with severe and enduring mental illness assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al., 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The “co-production of care” reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the “triangle of care” with carers bringing their own skills, resources and expertise. Originality/value – This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a “triangle of care”.


2021 ◽  
Vol 23 (2) ◽  
pp. 225-233
Author(s):  
*Louise I Rait ◽  
◽  
*Nikki Y Yeo ◽  
*Equal first authors ◽  
Yasmine Ali Abdelhamid ◽  
...  

BACKGROUND: Persistent psychological distress occurs frequently in family members of patients who die in an intensive care unit (ICU). OBJECTIVE: To determine the effectiveness of bereavement interventions in reducing persisting psychological distress in bereaved family members after death in an adult ICU. DESIGN: Systematic review and meta-analysis of studies that assessed the effect of bereavement interventions on persisting psychological distress in bereaved family members of ICU patients. DATA SOURCES: MEDLINE and APA Psycinfo databases were searched until April 2020. REVIEW METHODS: Two of us independently screened titles and abstracts of identified studies, and then completed full text evaluation of selected studies. We assessed risk of bias using version 2 of the Cochrane risk-of-bias tool for randomised trials and the Newcastle-Ottawa Scale, which is designed to assess the quality of non-randomised studies in meta-analyses. We also used random effects meta-analysis to assess the effect of various interventions on total Hospital Anxiety and Depression Scale (HADS) scores. RESULTS: From 664 citations, five studies were included — three multicentre randomised clinical trials and two single centre observational studies. Three studies tested the intervention of written bereavement support materials and two studies used narration of family members' experiences in the ICU. All studies reported HADS scores. Scores for Impact of Event Scale, Impact of Event Scale–Revised and Inventory of Complicated Grief were measured in some but not all studies. There was no effect of an intervention on HADS scores (weighted mean difference, −0.79 [95% confidence interval, −3.81 to 2.23]; Ι2 = 65.8%). CONCLUSIONS: Owing to limited data, and clinical and statistical heterogeneity, there is considerable uncertainty regarding whether bereavement support strategies reduce, increase or have no effect on psychological distress in bereaved family members.


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