Post-intensive Care Syndrome-family Research Articles

Interventions in Post-Intensive Care Syndrome-Family: A Systematic Literature Review.

Data show that family members of ICU patients may have high levels of anxiety, depression, posttraumatic stress disorders, and/or complicated grief. This was previously referred to as post-intensive care syndrome-family. We systematically review randomized controlled trials for post-intensive care syndrome-family. Systematic research in databases (Pubmed, EMBASE, PsycINFO, CINHAL for articles published between January 2000 and October 2019). Interventions in randomized controlled trials for post-intensive care syndrome-family in relatives of adult ICU patients. Review, quality assessment, and risk assessment for bias of eligible publications were performed along recommended guidelines for each investigation. Quality assessment graded studies into "strong" (n = 5), "moderate" (n = 4), and "weak" (n = 2). Out of 2,399 publications, 11 investigations were found eligible (3,183 relatives of ICU patients). Studies addressed interventions during ICU stay (n = 6), during the post-ICU period (n = 4), or both (n = 1). Two studies included relatives of dying/deceased patients. One study implemented end-of-life conferences and showed reduced prevalence of posttraumatic stress disorder (45% vs 69%; p = 0.01), anxiety (45% vs 67%; p = 0.02), and depression (29% vs 56%; p = 0.003). Family conferences with a physician and proactive participation of a nurse reduced anxiety-scores (p = 0.01) without reducing anxiety prevalence (33.3% vs 52.3%; p = 0.08). Other studies failed to improve symptoms or reduce prevalence of post-intensive care syndrome-family. Interestingly, condolence letters may even increase prevalence of posttraumatic stress disorder (52.4% vs 37.1%; p = 0.03). Meetings without the presence of ICU physicians were shown to increase Impact of Event Scale-Revised scores (25.9 vs 21.3; p = 0.0495). Only few data are available on interventions for post-intensive care syndrome-family. It appears that proactive communication and provision of information seems pivotal for post-intensive care syndrome-family treatment. Interestingly, some interventions may even worsen post-intensive care syndrome-family. In the light of the relevance of post-intensive care syndrome-family in daily ICU care, more high-quality data seems urgently needed.

The experiences and needs of relatives of intensive care unit patients during the transition from the intensive care unit to a general ward: A qualitative study

BackgroundRelatives of intensive care unit (ICU) patients play an important role as caregivers and can experience emotional distress, also referred to as post-intensive care syndrome-family. A deeper understanding of what relatives go through and what they need may provide input on how to strengthen family-centred care and, in the end, contribute to the reduction of symptoms of post-intensive care syndrome-family. MethodThis is a qualitative descriptive study with semistructured face-to-face interviews after ICU transfers. FindingsA total of 13 relatives of ICU patients participated. Relatives of ICU patients expressed five types of experiences after transfer from the ICU to the general ward: (1) relief, (2) uncertainty, (3) need to be acknowledged in becoming a caregiver, (4) sharing expectations, and (5) need for continuity in care. Relatives experience major uncertainties and prefer to be more actively involved in care and care decisions. ConclusionRelatives of ICU patients experience gaps in care during the transition from the ICU to a general ward. Nurses can play a crucial role in the need for continuity of care by proactively involving relatives during the care pathway of ICU patients.

Mitigating Post-Intensive Care Syndrome-Family: A New Possibility*

Mitigating Post-Intensive Care Syndrome-Family: A New Possibility*

Family-centred end-of-life care and bereavement services in Swedish intensive care units: A cross-sectional study.

Post-intensive care syndrome-family is a common problem in relatives of patients who die in an intensive care unit. Family-centred end-of-life care with support for the family during and after the death is supposed to prevent suffering and avoid illness. This study aimed to investigate family-centred end-of-life care and bereavement follow-up services offered to family members of patients who die in Swedish intensive care units. A cross-sectional study using a 16-question survey based on family-centred end-of-life care was sent to all 81 adult intensive care units. Data were analysed by descriptive statistics and chi-square. Respondents were able to add individual comments to the questionnaire. Although the majority (76.7%) offered some kind of follow up, this service was not always offered. Modes for invitation, timing, and contents in the follow up varied between the units. The staff tried to individualize the follow-up service according to the family's needs. Nurses and social workers were the only professionals who provided follow-up conversations on their own. Most of the intensive care units (97.3%) kept diaries that were handed over to the family when they left the unit after the patient's death or at a follow-up visit. Only 8.8% reported that they always offer the family the opportunity to be present during resuscitation. Most respondents reported that patients (60.6%) died in a private room. Family-centred end-of-life care varied among the intensive care units, and some families were not offered any follow up at all. Timing, invitation, and elements in the follow up differ between the units. Diaries were commonly kept and usually given to the family. Few units offered the family to be present during resuscitation. There is a need for national guidelines to ensure that all bereaved families receive equal and individual family-centred end-of-life care.

Intensive Care Unit Diaries, Part 1: Constructing Illness Narratives to Promote Recovery After Critical Illness

Intensive Care Unit Diaries, Part 1: Constructing Illness Narratives to Promote Recovery After Critical Illness

Important Outcomes for Parents of Critically Ill Children.

Important Outcomes for Parents of Critically Ill Children.

Postintensive care syndrome-family in Intensive Care Units: “What is it in the name?” A Scoping Definitive Review

Postintensive care syndrome-family in Intensive Care Units: “What is it in the name?” A Scoping Definitive Review

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

Staff and family response to end-of-life care in the ICU.

End-of-life (EOL) care can be stressful for clinicians as well as patients and their relatives. Decisions to withhold or withdraw life-sustaining therapy vary widely depending on culture, beliefs and organizational norms. The following review will describe the current understanding of the problem and give an overview over interventional studies. EOL care is a risk factor for clinician burnout; poor work conditions contribute to emotional exhaustion and intent to leave. The impact of EOL care on families is part of the acute Family Intensive Care Unit Syndrome (FICUS) and the Post Intensive Care Syndrome-Family (PICS-F). Family-centered care (FCC) acknowledges the importance of relatives in the ICU. Several interventions have been evaluated, but evidence for their effectiveness is at best moderate. Some interventions even increased family stress. Interventional studies, which address clinician burnout are rare. EOL care is associated with negative outcomes for ICU clinicians and relatives, but strength of evidence for interventions is weak because we lack understanding of associated factors like work conditions, organizational issues or individual attitudes. In order to develop complex interventions that can successfully mitigate stress related to EOL care, more research is necessary, which takes into account all potential determinants.

Post-intensive care syndrome symptoms and health-related quality of life in family decision-makers of critically ill patients.

Family members of critically ill patients can suffer symptoms of post-intensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder (PTSD) with a diminished quality of life. Our aim was to examine the relationship between coping strategies used by family decision-makers (FDMs) of critically ill patients and the severity of PICS-F symptoms and to examine the relationship between FDM PICS-F symptoms and health-related quality of life (HRQOL). A single-center, prospective, longitudinal descriptive study was undertaken of FDMs of intensive care unit (ICU) patients admitted to a large tertiary care hospital. PICS-F symptoms and coping strategy use were measured upon ICU admission (T1), 30 days (T2) after ICU admission, and 60 days (T3) after ICU admission. HRQOL was measured by the Short Form-36 version 2 at T1 and T3. We found a significant prevalence of anxiety (45.8%), depression (25%), and PTSD (11.1%) symptoms among FDMs over the course of the study. The patient mortality rate in our sample was 50%. The HRQOL mental summary score in FDMs was low at T1 and decreased to M = 41.72 (standard deviation = 12.47) by T3. Avoidant coping demonstrated moderate relationships with PTSD symptoms and anxiety at T3. A previous history of anxiety, depression, or PTSD was a significant predictor of PICS-F symptom severity and prevalence. PICS symptom severity at T3 explained 75% of the variance in HRQOL mental summary score.Significance of resultsThis study describes a significant prevalence of PICS-F symptoms in FDMs with a diminished mental HRQOL.

Measuring Outcomes of an Intensive Care Unit Family Diary Program.

Patients discharged from intensive care units are at risk of short- and long-term physical, cognitive, and emotional symptoms known as post-intensive care syndrome. Family members of intensive care unit patients are at risk of similar symptoms known as post-intensive care syndrome-family. Both syndromes are common, and strategies to reduce risk factors should be employed. An intensive care unit diary project to help reduce these syndromes was implemented in 2 intensive care units using an evidence-based framework. The effects of these diaries were studied using the Family Satisfaction with Care in the Intensive Care Unit survey. Rates of referrals to a postintensive care unit recovery clinic were also observed in relation to the diaries. Although preliminary data did not reveal a significant increase in family satisfaction, the surveys provided important staff feedback. The diaries fostered feelings of compassion and caring as well as built trust between staff and family members of intensive care unit patients. The diaries increased referrals to the postintensive care unit recovery clinic.

A Clinic Model: Post-Intensive Care Syndrome and Post-Intensive Care Syndrome-Family.

The number of patients surviving critical illness in the United States has increased with advancements in medicine. Post-intensive care syndrome and post-intensive care syndrome-family are terms developed by the Society of Critical Care Medicine in order to address the cognitive, psychological, and physical sequelae emerging in patients and their families after discharge from the intensive care unit. In the United Kingdom and Europe, intensive care unit follow-up clinics have been used to address the complications of post-intensive care syndrome for some time. However, the interprofessional clinic at Vanderbilt University Medical Center is among the first in the United States to address the wide variety of problems experienced by intensive care survivors and to provide patients and their families with care after discharge from the intensive care unit.

Developing a Diary Program to Minimize Patient and Family Post-Intensive Care Syndrome.

A series of evidence-based interventions beginning with an intensive care unit diary and a patient/family educational pamphlet were implemented to address the long-term consequences of critical illness after discharge from the intensive care unit, bundled as post-intensive care syndrome and post-intensive care syndrome-family. An extensive literature review and nursing observations of the phenomenon highlighted the potential for this project to have a favorable impact on patients, their families, and the health care team. The goal of this article is to explain the education of all stakeholders; the introduction of the diary, video, and educational pamphlet; and the evaluation of the acceptance of these interventions. This process began with an informal evaluation of the educational products and overall perception of the usefulness of the diary by patients, family members, and staff. The efforts described contribute to the evidence base supporting diaries as an adjunct to intensive care.

Ten practical strategies for effective communication with relatives of ICU patients.

Intensive care units (ICUs) manage critically ill patients at high risk of death or morbidity. For relatives of ICU patients, the experience can be extremely difficult, both during and after the ICU episode. Up to 70 % of family members (irrespective of patient survival) may develop psychological problems such as depression, anxiety, sleep disruption and post-traumatic stress disorder [1–7] known as ‘post-intensive care syndrome-family’ [4]. Poor communication experiences may contribute to preventable adverse psychological outcomes [3, 4, 7]. In this article we review the impact of critical illness on relatives and provide ten practical strategies to optimise communication with ICU relatives.

Psychologiczne reakcje członków rodzin chorych leczonych na oddziałach intensywnej terapii

The environment of the intensive care unit (ICU) is burdensome to a patient and the patient's family. There is a higher risk of depression, anxiety and stress-related disorders in the ICU patients' family members. In relatives of critically ill patients, the cluster of adverse psychological reactions, such as: anxiety, acute stress disorder, posttraumatic stress disorder, depression and complicated grief, is called post-intensive care syndrome - family (PICS-F). These complications may affect the relatives' ability to perform the role of a caregiver and it can also hinder their daily functioning. Apart from negative psychological consequences experienced after a loved one's stay in the ICU, there are also some positive changes observed in patient's relatives called posttraumatic growth. In this review, the psychological repercussions in the ICU patient's family and the means to prevent their undesirable responses are discussed.

A Vulnerable Population

Families of patients in adult critical care are susceptible to physiological symptoms, emotional distress, persuasion, burden, and postintensive care syndrome—family, as defined by the Society of Critical Care Medicine. The specific aims of this article are to (1) describe the state of science about the concept of vulnerability of families of patients in adult critical care, through analysis and synthesis of relevant literature; (2) explore resources available to reduce or prevent vulnerability of this population; and (3) propose considerations for research with this population. Concept analysis and synthesis strategies support the definition of this concept through review of the literature to describe antecedents, defining characteristics, and consequences of the vulnerability of families of patients in adult critical care. The authors present resources for both families and health care professionals and recommendations for potential collaborative efforts that could reduce risks and promote the health of this vulnerable population.

A Vulnerable Population

Families of patients in adult critical care are susceptible to physiological symptoms, emotional distress, persuasion, burden, and postintensive care syndrome-family, as defined by the Society of Critical Care Medicine. The specific aims of this article are to (1) describe the state of science about the concept of vulnerability of families of patients in adult critical care, through analysis and synthesis of relevant literature; (2) explore resources available to reduce or prevent vulnerability of this population; and (3) propose considerations for research with this population. Concept analysis and synthesis strategies support the definition of this concept through review of the literature to describe antecedents, defining characteristics, and consequences of the vulnerability of families of patients in adult critical care. The authors present resources for both families and health care professionals and recommendations for potential collaborative efforts that could reduce risks and promote the health of this vulnerable population.

From persistence to palliation

End-of-life care and communication deficits are important sources of conflicts within ICU teams and with patients or families. This narrative review describes recent studies on how to improve palliative care and surrogate decision-making in ICUs and compares the results with previously published literature on this topic. Awareness and use of end-of-life recommendations is still low. Education about end-of-life is beneficial for end-of-life decisions. Residency and nurses training programmes start to integrate palliative care education in critical care. Integration of palliative care consults is recommended and probably cost-effective. Projects that promote direct contact of care team members with patients/families may be more likely to improve care than educational interventions for caregivers only. The family's response to critical illness includes adverse psychological outcome ('postintensive care syndrome-family'). Information brochures and structured communication protocols are likely to improve engagement of family members in surrogate decision-making; however, validation of outcome effects of their use is needed. Optimizing palliative care and communication skills is the current challenge in ICU end-of-life care. Intervention strategies should be interdisciplinary, multiprofessional and family-centred in order to quickly reach these goals.

Having a loved one in the ICU

An appreciation of the post-ICU burden for family members, as well as the ways to prevent and minimize their symptoms of stress, anxiety, and depression. The long-term consequences of critical illness are growing in importance as the aging population increases its demand for critical care, and as the short-term mortality after critical illness decreases. Recently, postintensive care syndrome family was proposed as a new term for this cluster of psychological complications. Critical care providers are now recognizing the need to also address the psychological needs of the relatives earlier after ICU admission. A high proportion of family members present with symptoms of anxiety (70%) and depression (35%). Acute stress disorder and posttraumatic stress disorder (PTSD) related symptoms are also common. These symptoms are significantly more frequent when the relative is a spouse, or in bereaved family members. Few long-term data are available. However, in family members of dying patients, 1 year after the loss, up to 40% of them present with criteria for psychiatric illness such as generalized anxiety, major depressive disorders, or complicated grief. Prevention of post-ICU burden, mostly based on communication strategies, has been proposed to assist relatives.