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1.
PLoS One ; 17(3): e0264971, 2022.
Article in English | MEDLINE | ID: covidwho-1742014

ABSTRACT

BACKGROUND: Families of intensive care unit (ICU) decedents are at increased risk of experiencing complicated grief. However, factors associated with complicated grief in ICU and bereavement needs assessment are not available routinely. We aimed to conduct a systematic review identifying risk factors associated with complicated grief among family members of ICU decedents. MATERIALS AND METHODS: MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and Web of Science were searched to identify relevant articles. Observational studies and randomised and non-randomised controlled trials were included. Studies were screened and quality appraised in duplicate. Risk of bias was assessed using Newcastle-Ottawa Scale. A narrative synthesis was undertaken. RESULTS: Seven studies conducted across three continents were eligible. Four studies were of high quality. 61 risk factors were investigated across the studies. Factors associated with a decreased risk of complicated grief included age, patient declining treatment and involvement in decision-making. Factors associated with increased risk included living alone, partner, dying while intubated, problematic communication, and not having the opportunity to say goodbye. CONCLUSION: This systematic review has identified risk factors which may help identify family members at increased risk of complicated grief. Many of the studies has small sample sizes increasing the risk of erroneously reporting no effect due to type II error. Some factors are specific to the ICU setting and are potentially modifiable. Bereavement services tailored to the needs of bereaved family members in ICU settings are required. (PROSPERO registration ID 209503).


Subject(s)
Bereavement , Grief , Family , Humans , Intensive Care Units , Risk Factors
2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-317336

ABSTRACT

Background: The COVID-19 pandemic and ensuing healthcare crisis presented staff working in critical care with unprecedented demands. We sought to understand frontline staff’s experiences of working in critical care in the UK during the first wave of the outbreak.Methods: Between August and October 2020, we conducted qualitative, semi-structured telephone interviews with forty NHS staff who worked in critical care during the first wave of the pandemic in the UK. Staff were recruited from four hospitals and included doctors, nurses, allied health professionals and ward clerks. We purposefully sought the experiences of trained and experienced critical care staff and those who were redeployed. We analysed the data using Rapid Analysis and subsequently interpreted the findings using Baehr’s sociological lens of ‘communities of fate’.Findings: COVID-19 presented staff with a situation of extreme stress, duress and social emergency, leading to a shared set of experiences which we have characterised as a community of fate. This involved fear and dread of working in critical care, but also a collective sense of duty and vocation. Caring for patients and families involved changes to usual ways of working, revolving around: reorganisation of space and personnel, personal protective equipment, lack of evidence for treating COVID-19, inability for families to be physically present, and the trauma of witnessing extreme patient acuity and death on a large scale. The stress and isolation of working in critical care during COVID-19 was mitigated by strong teamwork, camaraderie, pride and fulfilment.Interpretation: COVID-19 has changed working practices in critical care and profoundly affected staff physically, mentally and emotionally. Attention needs to be paid to the social and organisational conditions in which individuals work, addressing both practical resourcing and the interpersonal dynamics of critical care provision.Funding: Medical Research Scotland, Wellcome TrustDeclaration of Interests: CM reports a grant from Medical Research Scotland during the conduct of the study;SH reports a grant from Florence Nightingale Foundation, outside the submitted work;SS reports grants from Wellcome Trust, during the conduct of the study;CMC, AD and NP declare no competing interests.Ethics Approval Statement: Ethical approval was granted by the University of Edinburgh School of Social and Political Science Research Ethics Committee;HRA approval (20/HRA/3270) was also obtained.

3.
BMJ Open ; 11(5): e048124, 2021 05 18.
Article in English | MEDLINE | ID: covidwho-1234303

ABSTRACT

OBJECTIVE: To understand National Health Service (NHS) staff experiences of working in critical care during the first wave of the COVID-19 pandemic in the UK. DESIGN: Qualitative study using semistructured telephone interviews and rapid analysis, interpreted using Baehr's sociological lens of 'communities of fate'. PARTICIPANTS: Forty NHS staff working in critical care, including 21 nurses, 10 doctors and advanced critical care practitioners, 4 allied health professionals, 3 operating department practitioners and 2 ward clerks. Participants were interviewed between August and October 2020; we purposefully sought the experiences of trained and experienced critical care staff and those who were redeployed. SETTING: Four hospitals in the UK. RESULTS: COVID-19 presented staff with a situation of extreme stress, duress and social emergency, leading to a shared set of experiences which we have characterised as a community of fate. This involved not only fear and dread of working in critical care, but also a collective sense of duty and vocation. Caring for patients and families involved changes to usual ways of working, revolving around: reorganisation of space and personnel, personal protective equipment, lack of evidence for treating COVID-19, inability for families to be physically present, and the trauma of witnessing extreme patient acuity and death on a large scale. The stress and isolation of working in critical care during COVID-19 was mitigated by strong teamwork, camaraderie, pride and fulfilment. CONCLUSION: COVID-19 has changed working practices in critical care and profoundly affected staff physically, mentally and emotionally. Attention needs to be paid to the social and organisational conditions in which individuals work, addressing both practical resourcing and the interpersonal dynamics of critical care provision.


Subject(s)
COVID-19 , Critical Care , Humans , Pandemics , Qualitative Research , SARS-CoV-2 , State Medicine , United Kingdom
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