Improving family experiences in ICU. Pamela Scott Senior Charge Nurse Forth Valley Royal Hospital ICU

Transcription

1 Improving family experiences in ICU Pamela Scott Senior Charge Nurse Forth Valley Royal Hospital ICU

2 Family Burden in icu:- Incidence of anxiety symptoms range from 21% to 60.4% (median 40%) from ICU admission and remains high though transitions of care to the ward Clinically relevant depressive symptoms range from 8% to 42% (median 23%) at admission and 23% at 12 months post discharge Risk factors associated with symptoms of anxiety and depression are younger patient age, younger relative, female gender and having a critically ill spouse

3 How can we reduce psychological burden? Communication is key when looking at strategies for reducing psychological burden Inadequate, inconsistent, poor quality communication associated with increased anxiety, depression and dissatisfaction with care Lack of regular meetings and inconsistent information is associated with increased risk of anxiety and symptoms of depression

4 Survivors vs Non Survivors - is there a communication difference Family members of patients who die in ICU are more satisfied with communication than family members of patients who survive ICU Reflect the extra effort and time hospitals and clinicians place on improving end of life care

5 Psychosocial interventions to improve psychological burden Lautrette et al (2007) RCT in 22 ICU s tested the effectiveness of a structured proactive family meeting on reducing PTSD, anxiety and depression for family members of ICU patients at the end of life lower prevalence of PTSD (45% versus 69%), lower anxiety (45% versus 67% ) and lower depression (29% versus 56% ) three months after the death of their family member in the ICU. Individualised techniques may have a greater effect on psychological well-being than non-individualized more general techniques. But intervention only applicable for patients dying

6 Psychological approaches for all patients Needs based educational sessions delivered on day 2 and 3 by bedside nurse (session takes 1 hour) Reduction in anxiety and higher levels of satisfaction with care Not a practical intervention in clinical practice But Again does show that proactive structured approach may be more beneficial than a general unstructured approach

7 Doctorate study American based intervention designed around a toolkit and its components was found for use in all ICU families. 3 specific tools as prototypes to facilitate the implementation of the ICU family meeting were published: 1) a planner, 2) a guide for families and 3) a medical documentation template

8 Aims of study The aims of this pilot study are: 1) To assess if the family meeting toolkit is likely to lead to reduced anxiety and depression and improve satisfaction in families of critically ill adults in ICU 2) To refine the intervention (toolkit) for a full scale definitive randomised controlled trial (RCT)

9 Research Hypotheses Two research hypotheses would be tested: There would be a significant reduction in anxiety and depressive symptoms in first degree family members who receive the family meeting provided by an ICU clinician within the first 72 hours of patients ICU admission and weekly thereafter, when compared with a control group who receive routine care given by ICU nursing and medical staff. There would be a significant increase in family satisfaction of care with families who received the family meeting toolkit when compared with a control group who received routine care by ICU nursing and medical staff

10 Eligible family members: The spouse or blood related family member of a mechanically ventilated critically ill adult No expectation of patient extubation or discharge from the ICU within the next 24 h this will control for wake and wean overnight patients Aged 18 years of age or above Available to participate in family meeting Exclusion criteria for family members: Family members not documented as next of kin Under 18 years of age, as those under 18 are not legally competent to provide consent (Tisdall et al 2009). Unable to complete the questionnaires because of language, cognition or cultural barriers

11 Primary Outcome Measures 2 research instruments that measure anxiety and depressive symptoms and family satisfaction will be completed at baseline and prior to discharge The Hospital Anxiety and Depression Scale (HADS) Family satisfaction (FS-ICU)

12 Qualitative study Semi Structured interviews will be analysed using Qualitative Content analysis to explore satisfaction with the study documentation used, perceived barriers with using the tools and satisfaction with family- clinician communication.

13 Limitations of the study It is hoped that this toolkit will reduce family symptoms of anxiety and depression and improve satisfaction; these outcomes are subjective and could allow for the introduction of bias if the family members who received the interventions give different ratings because they want to please the researchers, not because the intervention improved their experiences. It is hoped that by resurveying prior to discharge they would have spent limited time with the researcher which may reduce this desire to please although it is important to acknowledge this limitation.

14 Strengths of the study This is the first study to test the feasibility and acceptability of a family centred toolkit for families of critically ill adults in the UK. First step in acknowledging and addressing impact of family burden in icu Qualitative interviews will enrich quantitative findings

15 Thank you