Pilot Randomized Trial of a Recovery Navigator Program for Survivors of Critical Illness With Problematic Alcohol Use.

Many survivors of critical illness have problematic alcohol use, associated with risk of death and hospital readmission. We tested the feasibility, acceptability, treatment fidelity, and potential efficacy of a customized alcohol intervention for patients in ICUs. The intervention was delivered by a Recovery Navigator using principles of motivational interviewing and shared decision-making. DESIGN: Pilot randomized trial. SETTING: Two urban ICUs in Denver, CO. PATIENTS: Patients with problematic alcohol use were enrolled prior to hospital discharge. INTERVENTIONS: Patients were randomly assigned to usual care, single-session motivational interviewing and shared decision-making, or multisession motivational interviewing and shared decision-making. MEASUREMENTS AND MAIN RESULTS: We assessed feasibility via enrollment and attrition, acceptability via patient satisfaction (Client Satisfaction Questionnaire-8), fidelity via observation and questionnaires, and potential efficacy via group means and CIs on measures of alcohol use, psychiatric symptoms, cognition, and other alcohol-related problems. Over 18 months, we offered the study to 111 patients, enrolled 47, and randomized 36; refusals were mainly due to stigma or patients' desire to handle problems on their own. Groups were similar at baseline, and 67% of patients met criteria for alcohol use disorder. Average patient satisfaction was high (mean = 28/32) regardless of group assignment. Sessions were delivered with 98% adherence to motivational interviewing principles and excellent motivational interviewing spirit; patients perceived the intervention to be more autonomy supportive than usual care. Group means after 6 months suggested that patients receiving the intervention might improve on measures such as alcohol use, psychiatric symptoms, legal problems, and days of paid work; however, they did not receive more substance use treatment. All results were nonsignificant due to small sample size. CONCLUSIONS: A Recovery Navigator intervention was feasible and acceptable for delivering high-fidelity brief interventions to ICU patients. Changes in alcohol-related problems with motivational interviewing and shared decision-making were nonsignificant but clinically meaningful in size. A full-scale randomized trial of motivational interviewing and shared decision-making is warranted.

Designing a Resilience Program for Critical Care Nurses.

BACKGROUND: Workplace stress can affect job satisfaction, increase staff turnover and hospital costs, and reduce quality of patient care. Highly resilient nurses adapt to stress and use a variety of skills to cope effectively. OBJECTIVE: To gain data on a mindfulness-based cognitive therapy resilience intervention for intensive care unit nurses to see if the intervention program would be feasible and acceptable. METHODS: Focus-group interviews were conducted by videoconference with critical care nurses who were members of the American Association of Critical-Care Nurses. The interview questions assessed the feasibility and acceptability of a mindfulness-based cognitive therapy program to reduce burnout syndrome in intensive care unit nurses. RESULTS: Thirty-three nurses participated in 11 focus groups. Respondents identified potential barriers to program adherence, incentives for adherence, preferred qualifications of instructors, and intensive care unit-specific issues to be addressed. CONCLUSIONS: The mindfulness-based cognitive therapy pilot intervention was modified to incorporate thematic categories that the focus groups reported as relevant to intensive care unit nurses. Institutions that wish to design a resilience program for intensive care unit nurses to reduce burnout syndrome need an understanding of the barriers and concerns relevant to their local intensive care unit nurses.

The Experience of Patients with Alcohol Misuse after Surviving a Critical Illness. A Qualitative Study.

RATIONALE: Alcohol misuse is common in patients admitted to the intensive care unit (ICU), but there is currently no evidence-based approach to address drinking in ICU survivors. OBJECTIVES: We sought to describe the experience of ICU survivors with alcohol misuse during their hospitalization and the 3 months after hospital discharge to inform an alcohol-specific intervention for this unique population. METHODS: We conducted a descriptive qualitative study of ICU survivors from medical ICUs in three separate hospitals with a positive screening result on the Alcohol Use Disorders Identification Test. Semistructured interviews were conducted 3 months after hospital discharge of patients. Patients were also allowed to nominate up to two friends or family members for enrollment to provide additional perspective on the patient's experience. RESULTS: We enrolled 50 patients and 22 of their friends and/or family members. The average APACHE II score was 23, 80% of patients were male, and the average age was 50 years; 70% of patients and 77% of friends/family members completed the semistructured interview 3 months after hospital discharge. We identified three domains that could inform an alcohol-specific intervention, each with multiple themes: motivation with complications (anxiety and depression, critical illness as a catalyst, delirium and cognitive impairment); therapeutic alliance (autonomy, failure and opportunities to build a therapeutic alliance); and the return to the home milieu (lack of screening for depression and anxiety, social network support for drinking, social isolation, social network support for abstinence, lack of available and affordable treatment, and negative experiences with Alcoholics Anonymous). CONCLUSIONS: An alcohol intervention for ICU survivors would account for the context in which patients are making a decision about their drinking and optimize the patient-provider interaction. Contrary to current paradigms that focus on addressing alcohol consumption only during a hospitalization, an intervention for ICU survivors should continue as patients transition from the hospital to home.