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Having a family member, regardless of their age, admitted to an intensive care unit (ICU) is a stressful event, and research has documented that such stress may contribute to depression, anxiety and posttraumatic stress disorder (PTSD).
The Society of Critical Care Medicine (SCCM) recently updated guidelines for family-centered care in ICU settings, which state that part of a nurse’s role is to assess stress among family members of a critically ill patient and to intervene to help reduce this stress.
“Nursing Interventions to Reduce Stress in Families of Critical Care Patients: An Integrative Review” responds to the SCCM guidelines by aiming to establish the state of knowledge regarding the stress experienced by families with a loved one in the ICU and to identify specific nursing interventions that may help.
Authors Valèrie Lebel, PhD, RN, and Sylvie Charette, PhD, RN, are professors in the department of nursing, at the Universitè du Quèbec en Outaouais (University of Quebec Outaouais), in Canada.
“The COVID-19 pandemic has reinforced that ICU nurses are the main point of interaction between the healthcare team and the family and that they are crucial to supporting the family through the ICU experience,” Lebel said. “A family-centered approach makes it possible to implement tailored interventions that are flexible and accommodate individual coping strategies.”
Their literature search of three databases (MEDLINE, CINAHL, and Cochrane) identified 934 research articles with select keywords related to the topic in the abstract or summary. The search covered the period from 2007, when the first SCCM family-centered care guidelines were issued, through 2019. From these, they removed duplicates and applied inclusion criteria, resulting in a total of 38 articles for the integrative review. Of these, 18 studies dealt with the neonatal ICU setting, nine were in pediatric ICUs, and 11 were in adult ICUs, most of which were medical and surgical ICUs.
The article summarizes the design and findings of all 38 research studies, with principal stressors for families and related nursing interventions. The analysis found that, in all three care settings, the sources of stress fell into four main categories:
- Changes in the relationship between the patient and family
- Altered appearance and behavior of the patient
- Highly specialized care setting with unfamiliar medical equipment and healthcare staff
- Communication and counseling with the healthcare staff
For each stressor, the researchers identified specific nursing interventions, such as using a family-centered approach to care and implementing appropriate stress-reducing interventions. Overall, their findings recommend that nursing interventions focus on valuing the role of family members in patient care, improving communication and providing accurate information.
Reducing family members’ stress during a loved one’s ICU stay may also help with efforts to reduce family post-ICU syndrome, with its mental health issues and decreased quality of life. In addition, more research is needed to develop tools to evaluate family members’ level of stress and principal stressors, as well as the most effective interventions to improve the family’s experience of intensive care.
As the American Association of Critical-Care Nurses’ (AACN’s) bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.
Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.
About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of more than 120,000 and can be accessed at http://ccn.aacnjournals.org/.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.
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