Intensive Care Unit Caregivers Research Articles

0999 Stress, Sleep Disturbances and Coping Strategies Among Taiwanese Primary Family Caregivers in Intensive Care Units

0999 Stress, Sleep Disturbances and Coping Strategies Among Taiwanese Primary Family Caregivers in Intensive Care Units

"How Do I Test the Waters? How Do I Go Forward?": Codesigning a Supportive Pathway after Critical Illness.

Rationale: Long-term recovery after critical illness can be affected by post-intensive care syndrome (PICS), a significant burden, which can impact return to activities and work. There is a need for streamlined support for intensive care unit (ICU) patients in their recovery while enduring PICS symptoms. Objectives: To explore critical illness recovery from the experiences, perspectives, and beliefs of former ICU patients, their caregivers, and multidisciplinary clinicians to design a future rehabilitation intervention prototype to support ICU patients. Methods: This was an experience-based codesign (EBCD) study underpinned by the Behavior Change Wheel framework involving ICU patients (<5 years after illness), caregivers, and multidisciplinary clinicians with current clinical experience with ICU recovery at any point along the care continuum (ICU, acute, subacute, or community settings) from two metropolitan hospitals in Melbourne, Australia. Two rounds of experience-based codesign workshops were held between August 2021 and February 2022. Workshop content was analyzed via a reflective thematic approach to determine themes and develop an intervention. The intervention was mapped according to the template for intervention description and replication framework. Results: Forty people participated in the codesign process: 15 ICU patients, 2 caregivers, and 23 clinicians. Fifteen major themes were identified in the experience of ICU recovery. Returning home was a key time point for change, acceptance, and adjustment, with the burden of physical limitations and mental health problems becoming apparent. Most participants expressed that PICS was poorly understood in the community, and there was a lack of support to aid recovery. Based on these results, an intervention prototype was developed with a primary goal of improving care after hospital discharge. This was further refined in the second round of workshops. A resource toolkit was deemed most acceptable to end-users, including a hospital-directed support program involving psychology and physical therapy and an accompanying digital health package. Conclusions: A critical time point for more support in the recovery journey was the transition from hospital to home. To address this, a rehabilitation prototype including a physical and psychological support intervention and supporting digital health toolkit was codesigned. The intervention package will be developed and trialed with future ICU patients and their families. Clinical trial registered with www.clinicaltrials.gov (NCT05044221).

Care intervention on psychological outcomes among patients admitted to intensive care unit: an umbrella review of systematic reviews and meta-analyses

BackgroundNumerous studies have explored care interventions to improve the psychological outcome of intensive care unit (ICU) patients, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to get familiar with all available literature and find appropriate interventions. This umbrella review aimed to analyze the relationship between care intervention and psychological outcomes of ICU patients based on existing systematic reviews.MethodsAn umbrella review of evidence across systematic reviews and meta-analyses published between 1987 and 2023 was undertaken. We systematically searched reviews that examined the association between care intervention and the improvement of adverse psychological outcomes in ICU patients using PubMed, EMBASE, Web of Science, Cochrane Library, and manual reference screening. The measurement tool (AMSTAR 2) was applied to evaluate the methodological quality of included studies. The excess significance bias, between-study heterogeneity expressed by I2, small-study effect, and evidence class were estimated.ResultsA total of 5110 articles were initially identified from the search databases and nine of them were included in the analysis. By applying standardized criteria, only weak evidence was observed in 13 associations, even though most included reviews were of moderate to high methodological quality. These associations pertained to eight interventions (music therapy, early rehabilitation, post-ICU follow-up, ICU diary, information intervention, preoperative education, communication and psychological support, surrogate decision-making) and five psychological outcomes (post-intensive care syndrome, transfer anxiety, post-traumatic stress disorder, anxiety, and depression). Weak or null association was shown among the rest of the associations (e.g., weak association between music therapy and maternal anxiety or stress level).ConclusionsThe evidence of these eight supporting interventions to improve the adverse psychological outcomes of ICU patients and caregivers was weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence.

Using Simulation-Based Training to Improve Neonatal Resuscitation Clinical Competency, Confidence, and Comfort Level of NICU Caregivers.

Approximately 10% of newborns require resuscitation at delivery or during a neonatal intensive care unit (NICU) stay. Neonatal intensive care unit caregivers competent in providing neonatal resuscitation decrease perinatal mortality and improve neonatal outcomes. Infrequency of resuscitation events, lack of repetition, and inexperience leave caregivers feeling un-prepared for emergency situations. There is a need for educational strategies to maintain competency and increase confidence and comfort level. This quality improvement project used a pre-post survey design. Competency was assessed during simulated mock codes using the Creighton Competency Evaluation Instrument. Self-perceived confidence and comfort level were assessed using a pre-post survey. Descriptive statistics indicated that the average score on the Creighton Competency Evaluation Instrument fell below the targeted minimally competent goal of 80%. Practical significance was noted between the pre-intervention and post-intervention means of both perceived confidence and comfort level. Simulation-based education may increase the competency, confidence, and comfort level of NICU caregivers and should be conducted routinely. Similar projects could be replicated at other institutions to address continuing competency with neonatal resuscitation. [J Contin Educ Nurs. 2024;55(4):175-180.].

Health and Well-Being of Intensive Care Unit Physicians: How to Ensure the Longevity of a Critical Specialty.

A second epidemic of burnout, fatigue, anxiety, and moral distress has emerged concurrently with the coronavirus disease 2019 (COVID-19) pandemic, and critical care physicians are especially affected. This article reviews the history of burnout in health care workers, presents the signs and symptoms, discusses the specific impact of the COVID-19 pandemic on intensive care unit caregivers, and attempts to identify potential strategies to combat the Great Resignation disproportionately affecting health care workers. The article also focuses on how the specialty can amplify the voices and highlight the leadership potential of underrepresented minorities, physicians with disabilities, and the aging physician population.

Implementing Standardized Post-Intensive Care Syndrome Education by an Advanced Practice Registered Nurse in the Pediatric Intensive Care Unit

Implementing Standardized Post-Intensive Care Syndrome Education by an Advanced Practice Registered Nurse in the Pediatric Intensive Care Unit

Burnout Syndrome During COVID-19 Second Wave on ICU Caregivers.

The main objective of this article is to evaluate the prevalence of burnout syndrome (BOS) among the Intensive Care Unit (ICU) healthcare workers. The COVID-impact study is a study conducted in 6 French intensive care units. Five units admitting COVID patient and one that doesn't admit COVID patients. The survey was conducted between October 20th and November 20th, 2020, during the second wave in France. A total of 208 professionals responded (90% response rate). The Maslach Burnout Inventory scale, the Hospital Anxiety and Depression Scale and the Impact of Event Revisited Scale were used to study the psychological impact of the COVID-19 Every intensive care unit worker. The cohort includes 208 professionals, 52.4% are caregivers. Almost 20% of the respondents suffered from severe BOS. The professionals who are particularly affected by BOS are women, engaged people, nurses or reinforcement, not coming willingly to the intensive care unit and professionals with psychological disorders since COVID-19, those who are afraid of being infected, and people with anxiety, depression or post-traumatic stress disorder. Independent risk factors isolated were being engaged and being a reinforcement. Being a volunteer to come to work in ICU is protective. 19.7% of the team suffered from severe BOS during the COVID-19 pandemic in our ICU. The independent risk factors for BOS are: being engaged (OR = 3.61 (95% CI, 1.44; 9.09), don't working in ICU when it's not COVID-19 pandemic (reinforcement) (OR = 37.71 (95% CI, 3.13; 454.35), being a volunteer (OR = 0.10 (95% CI, 0.02; 0.46). Our study demonstrates the value of assessing burnout in health care teams. Prevention could be achieved by training personnel to form a health reserve in the event of a pandemic.

A multicentre evaluation exploring the impact of an integrated health and social care intervention for the caregivers of ICU survivors

BackgroundCaregivers and family members of Intensive Care Unit (ICU) survivors can face emotional problems following patient discharge from hospital. We aimed to evaluate the impact of a multi-centre integrated health and social care intervention, on caregiver and family member outcomes.MethodsThis study evaluated the impact of the Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme across 9 sites in Scotland. InS:PIRE is an integrated health and social care intervention. We compared caregivers who attended this programme with a contemporary control group of ICU caregivers (usual care cohort), who did not attend.ResultsThe primary outcome was anxiety measured via the Hospital Anxiety and Depression Scale at 12 months post-hospital discharge. Secondary outcome measures included depression, carer strain and clinical insomnia. A total of 170 caregivers had data available at 12 months for inclusion in this study; 81 caregivers attended the InS:PIRE intervention and completed outcome measures at 12 months post-hospital discharge. In the usual care cohort of caregivers, 89 completed measures. The two cohorts had similar baseline demographics. After adjustment, those caregivers who attended InS:PIRE demonstrated a significant improvement in symptoms of anxiety (OR: 0.42, 95% CI: 0.20–0.89, p = 0.02), carer strain (OR: 0.39; 95% CI: 0.16–0.98 p = 0.04) and clinical insomnia (OR: 0.40; 95% CI: 0.17–0.77 p < 0.001). There was no significant difference in symptoms of depression at 12 months.ConclusionsThis multicentre evaluation has shown that caregivers who attended an integrated health and social care intervention reported improved emotional health and less symptoms of insomnia, 12 months after the delivery of the intervention.

Integration of IoT and Fog Computing in Healthcare Based the Smart Intensive Units

Internet of Things (IoT) has enormous capability to revolutionize medical care and enhance global health indicators in the health sector. The Intensive Care Unit (ICU) is an important part of the medical sector because it treats patients who have suffered a terrible accident, have a very serious or life-threatening condition or are undergoing an effective medical treatment that necessitates 24-hour care and support. For this reason, one of the most important issues that hospitals suffer is lack of patient monitoring systems cause ICU health attendants and doctors were overburdened, which can lead to medical errors due to a huge workload that exceeded their ability. As a result, even a minor delay in recognizing a patient&#x2019;s deterioration might result in severe disability or death. Therefore, continuously patient monitoring in ICU is the most crucial process. That&#x2019;s why a way to optimize the ICU monitoring procedure in order to minimize delayed detection and reduce the workload of ICU doctors and caregivers is needed. In this study, we proposed a smart IoT-based ICU patient monitoring system to help doctors and hospitals to monitor the patients continuously and in making quick decisions. Our proposed method can measure patient&#x2019;s body parameters (temperature, SpO2, heartbeat, blood pressure, ECG, and it can also measure glucose, lactate, blood circulation, red blood cells, white blood cells, calcium, potassium from the patient fluids) in real-time and in case of anomalous values of the patient&#x2019;s body parameters, the device will send a notification to the assigned doctor and the Emergency Care Unit (ECU) of the hospital. Doctors can also monitor the patient remotely through our system.

Effect of an information and communication technology program on the anxiety of coronary artery bypass graft patients’ caregivers in intensive care unit

Effect of an information and communication technology program on the anxiety of coronary artery bypass graft patients’ caregivers in intensive care unit

In What Ways Has the COVID-19 Crisis Been a Challenge for Caregivers in Intensive Care Units in Terms of Their Relationship with Their Patients’ Relatives?

Background: The intensive care unit (ICU) is a technical environment where patients’ lives are at risk. The COVID-19 pandemic has led to for visitors of patients hospitalised in ICUs.Methods: A qualitative study including 10 semi-directive interviews with caregivers working in an ICU. Results: The COVID-19 crisis disrupted the inclusion of patients’ relatives in the ICU. Their inclusion had been established by various means before the crisis: 24-hour visits, participation in mortuary toilets, pets’ visits, logbooks, family lounges, and volunteer visits. These options led to better inclusion in the ICU, even if there were still difficulties: involving the patients’ loved ones during the acute phase, communicating with the visitors, waiting for care, choosing a healthcare proxy, and coping with restricted visiting hours. The COVID-19 crisis added barriers: the initial closure of all the wards in which the interviewed caregivers worked, followed by their partial reopening; a fear of the virus; equipment related constraints; exacerbated communication difficulties; and an extreme lack of medical time. The caregivers tried to implement new means of including relatives in this context: videoconferencing, virtual logbooks, and regular telephone interviews. However, the global context of the pandemic made it difficult for hospital professionals to accommodate the patients’ loved ones, thus deteriorating caregivers’ relationships with relatives, resulting in negative experiences for both relatives and caregivers.Conclusion: The COVID-19 crisis has made it challenging for caregivers to accommodate the relatives of hospitalised patients. Despite the means implemented to maintain a link between caregivers and family members, face-to-face relationships are necessary for humane patient care.Funding: None to declare.Declaration of Interest: None to declare. Ethical Approval: This study was approved by an IRB. It did not request any further approval according to French law

Psychological Impact of COVID-19 on ICU Caregivers

Subject and purposeJust as every pandemic, COVID-19 could lead to emotional and psychological disturbances among caregivers, especially in the Intensive Care Unit (ICU), where significant stress related to the influx of patients, exposure to the virus and the lack of documentation on this new SARS occurred. The present study aimed at assessing the psychological impact of COVID-19 on the caregivers at the peak of the “crisis period”. Materials and methodsA survey using the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale – Revised (IES-R) was proposed to the persons working in 5 ICUs of a French teaching hospital (8th of April to the 21st of April 2020). Logistic regression was performed to find independent risk factors for anxiety and post-traumatic stress disorder (PTSD). A value of p < 0.05 was considered significant. ResultsThe incidence of anxiety and depression were 48% and 16%, respectively. PTSD symptoms were present in 27% of respondents. The independent risk factors for developing anxiety syndrome were being assigned in COVID-19 + ICU (OR = 2.081 [95% confident interval (CI), 1.035-4.184)], and not be trained in intensive care medicine, OR = 2.570 [95% CI, 1.344-4.901]. The independent risk factors for PTSD are having a history of burn-out (OR = 4.591 [95% CI, 1.464-14.397] and not being trained in ICU, (OR = 2.155 [95% CI, 1.047-4.440]). ConclusionCOVID-19 could have a strong impact on ICU workers. These findings should lead to prevention procedures (ICU training sessions) in persons at risk.

Pain and Delirium in Critical Illness: An Exploration of Key 2018 SCCM PADIS Guideline Evidence Gaps

Managing pain and delirium are crucial to patients, families, and caregivers in intensive care units. The Society of Critical Care Medicine 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep disruption (PADIS) guidelines reviewed literature until October 2015 and made its recommendations for critically-ill adults. This chapter addresses evidence gaps, identified during the guideline process, most relevant to clinicians, adds newer evidence published after the PADIS 2018 guidelines were produced, describes hindsight-driven PADIS process or content-related gaps, and reflects on how these considerations may help inform future research investigations and new guideline efforts.

Swanson's Theory of Caring: An Application to the Role of Nursing Education

Swanson's Theory of Caring emerged from three phenomenological studies carried out in three separate perinatal contexts. Contexts included women who had miscarried, neonatal intensive care unit caregivers, and mothers deemed socially at risk.Swanson identified five caring processes or constructs in the miscarriage study: knowing, being with, doing for, enabling, and maintaining belief. This author conducted a field exercise to test whether the five constructs comprising Swanson's Theory of Caring could be applied to students' evaluation of faculty. The results indicated that students could apply Swanson's Theory of Caring to the evaluation of faculty.

A novel GA-ELM model for patient-specific mortality prediction over large-scale lab event data

Patient-specific mortality prediction models are an essential component of Clinical Decision Support Systems developed for caregivers in Intensive Care Units (ICUs), that enable timely decisions towards effective patient care and optimized ICU resource management. While high prediction accuracy is a fundamental requirement for any mortality prediction application, being able to so with minimal patient-specific data is a major plus point that can help in improving care delivery and cost optimization. Most existing scoring techniques and prediction models utilize a multitude of lab tests and patient events to predict mortality and also suffer from reduced performance when available patient data is less. In this paper, a Genetic Algorithm based Wrapper Feature Selection technique is proposed for determining most-optimal lab events that contribute predominantly to mortality, even for large-scale patient cohorts. Using this, an Extreme Learning Machine (ELM) based neural network is designed for predicting patient-specific ICU mortality. The proposed GA-ELM model was benchmarked against four popular traditional mortality scores and also state-of-the-art machine learning models for experimental validation. The GA-ELM model achieved promising results as it outperformed the traditional scoring systems by 11%–29% and state-of-the-art models by up to 14%, in terms of AUROC.

Burden and Psychological Distress of Intensive Care Unit Caregivers of Traumatic Brain Injury Patients.

ABSTRACTAimAdmission to Intensive Care Unit (ICU) is a stressful event and unforeseen crisis for the caregivers. Burden and psychosocial distress among caregivers in the ICU were unexplored. Therefore, the current study was aimed to assess the caregivers’ burden and psychological distress among caregivers of traumatic brain injury (TBI) patients at emergency ICU during hospitalization.Materials and MethodsA total of 60 caregivers recruited by using purposive sampling method with descriptive research design. Consent was obtained. Interview schedule of family for depression, anxiety, stress scale (DAS-21) were administered. The data were analyzed by using SPSS. Descriptive statistics and independent burden t-test were used.ResultsResults revealed that male caregivers (75%) and female caregivers (25%) took part in the study. Caregivers' mean age was found to be 35.22±11.29 years. Most of the TBI survivors admitted in ICU had severe injury (8.30±3.63). Mean scores showed that caregivers had experienced financial burden (6.28±2.36), severe depression (12.15±4.84), and a moderate level of anxiety (12.85±5.20). Independent t-test showed significant difference in caregiving burden between male and female caregivers at ICU (Male = 18.43±4.83; Female = 14.29±4.83; t = 2.16; p <0.035). Overall, caregivers experienced higher family burden and severe psychological distress at ICU.ConclusionThere is an immediate need to assess psychological distress and family burden of caregivers at ICU and provide timely psychosocial intervention.How to cite this articleKanmani TR, Thimmappur RM, Birudu R, Reddy KN, Raj P. Burden and Psychological Distress of Intensive Care Unit Caregivers of Traumatic Brain Injury Patients. Indian J Crit Care Med 2019;23(5):220-223.

Burn-Out Chez Le Personnel Soignant Des Unités De Soins Intensifs De L’hôpital Universitaire De Parakou Au Bénin

The aim of the study was to identify Burn-out factors among caregivers in intensive care units in University Hospital of Parakou. We used a descriptive, analytical and correlational study with prospective data collection carried out over four months (March 1 to June 30, 2015) and 123 caregivers concerned consenting to the study. The Maslach Burn-out Inventory (MBI) was used for the assessment of burnout of the respondents. Among the 143 agents identified, 123of them (86%) consented to the survey. The average age of caregivers was 34.4 ± 9.3 years with a male predominance (56.9%). Seventy-six caregivers lived with a partner (61.8%) and 90.8% of them were monogamous. Seventy-one caregivers (57.7%) were not satisfied with their socio-economic situations and 88.7% of them associate secondary activities. Eighty eight caregivers (71.5%) were identified in their industry stressful conditions. The frequency of Burn-out was 68.3%. The occurrence of burn out was associated with sex (p = 0.001), type of family (p = 0.001), vocational qualification (p = 0.001) in the industry (p = 0 001), socio-economic conditions (p = 0.01), disease appeared in the exercise of the profession (p = 0.02), organizational factors (p = 0.001) and stressful conditions (p = 0.04). In conclusion we observe that the function nurse in the intensive care unit of the University Hospital of Parakou has a physical and mental hardship among caregivers inducing a high score of Burn-out, implementing an adapted prevention program is therefore necessary to lowering it.

Stress, stress-related symptoms and social support among Taiwanese primary family caregivers in intensive care units

ObjectivesTo explore the associations between stress, sleep disturbances, fatigue severity and social support among primary family caregivers in intensive care units during the early period of ICU hospitalisation. DesignCross-sectional, descriptive correlational study. SettingIntensive Care Units in a teaching hospital in Taiwan. Main outcome measuresPerceived stress (Impact of Events Scale-Revised), sleep disturbances (General Sleep Disturbance Scale), fatigue severity (Lee’s Fatigue Scale), social support (Norbeck Social Support Questionnaire) and one open-ended question. ResultsThe primary family caregivers (N = 87) were distressed and experienced poor sleep quality and fatigue during the early period of ICU hospitalisation. Primary family caregivers have various social support needs but being updated on the patients’ prognosis was at the top of the list. Perceived ICU hospitalisation stress was the only significant predictor for fatigue while age along with perceived event stress were the significant predictors for sleep disturbances. ConclusionStress-coping interventions are needed to reduce stress-related symptoms for the primary family caregivers. Social supports did not buffer stress in this study, which calls for further research to explore the culture variance and quality of social support.

Initiative for Burnout of ICU Caregivers: Feasibility and Preliminary Results of a Psychological Support

Intensive care unit (ICU) caregivers are at high risk of burnout and the shortage of this highly specialized personal is a problem. The feasibility and impact of a psychological intervention were never assessed in this special context. A randomized controlled single-blind study in an ICU. The first intervention consisted in weekly problem-based sessions led by psychologists with small groups of caregivers using a systemic approach over 3 months. The modified intervention was lead for 9 months. The scores of Maslach Burnout Inventory and Hospital Anxiety and Depression Scale were compared between the intervention and control groups, before and after the intervention. One-hundred and sixty six caregivers were randomized in intervention and control groups. The major finding was the way the psychologists could modify the original methodology in order to enable caregivers to attend the sessions. Burnout scores tended to decrease across the whole ICU team after the intervention period, more in the intervention group. Participation in the study was poor at 6 months after intervention. This is the first study attempting to evaluate a psychological intervention on the mental health of ICU caregivers. It shows a modified method of a psychological support with a systemic approach in the special environment of ICU. Notwithstanding the modest results related to the short length of the process and the turnover of the personal, we demonstrated that such an approach is feasible. Further studies on larger scale and of longer duration are needed to investigate the effect of such interventions on the mental health of ICU caregivers.

A Qualitative Pilot Study on Donation After Cardiac Death (DCD)

Aim DCD is considered a viable solution to reduce organ shortage, but it raises serious ethical and psychological issues that cannot be ignored. Understanding what alters DCD acceptance by ICU caregivers is important to run a sustainable DCD program and to offer an adapted support for the personnel involved. The aim of our research was to shed new light on feelings experienced by caregivers when involved in DCD. Methods We conducted an exploratory qualitative study before the introduction of DCD to investigate how ICU caregivers at the Geneva University Hospitals perceive DCD and how they associate this practice to ethical interrogations. Our qualitative study was based on three semi-structured focus groups with a sample of twenty-four caregivers (nurses, physicians and care assistants). Results Our analysis of caregivers’ feelings toward DCD showed the presence of various stress factors which are perceived as potential barriers to DCD acceptance. The temporal proximity between therapeutic withdrawal decision and organ donation process introduces a sense of “conflict of duty” in caregivers. Brain death not being central in DCD, traditional landmarks in donation are lost, which makes caregivers uncomfortable with this procedure. Some ICU professionals are afraid of families’ and public’s judgment. Some of them may perceive incoherence between social desirability and individual values. Taking into account all these issues, we can also observe that the majority of caregivers are able to deal with these complexities; they do not reject DCD but on the contrary they made several suggestions which are intended to reduce psychological impact of DCD, such as a desire of objectivity regarding DCD criteria or the training of specialised professionals to achieve DCD process. They stated being in favour of organ donation and in addition, we also observe trust in the DCD program and a high level of support within ICU. Conclusion Our qualitative study highlights major psychological distress induced by DCD, which represents a potential barrier to DCD acceptance in ICU. However, we can also observe that caregivers are able to deal with DCD difficulties by proposing solutions which are intended to reduce its psychological impact. In view of our results, we can consider if the introduction of DCD in the ICU should be accompanied by a program of psychological support to help caregivers dealing with this new and demanding activity. A pilot study on the feelings experienced by the nursing and medical staff in the adult intensive care unit (ICU) of the Geneva University Hospitals. This study was financially supported by the Department of Anaesthesiology, Pharmacology and Intensive Care Medicine Research Fund. The Geneva University Hospital DCD program is financially supported by the Geneva University Hospitals Private Foundation. We also gratefully acknowledge the support of Dynèle Gautier and also all the adult intensive care unit who has always been highly collaborative.