Feasibility and acceptability of conducting a partially randomised controlled trial examining interventions to improve psychological health after discharge from the intensive care unit.

BACKGROUND: Interventions to support psychological recovery after critical illness, including information provision via an intensive care unit (ICU) diary or discharge summary, have been widely adopted in some regions, albeit without strong empirical evidence. OBJECTIVE: The objective of this study was to examine the feasibility and acceptability, for patients, family members, and clinicians, of information provision via an ICU diary or discharge summary to support psychological recovery for critical illness survivors. METHODS: This was a pilot, partially randomised patient preference study in a mixed ICU in a tertiary hospital in Australia. Eligible patients were those in the ICU for >24 h and who were able to converse in English. Interventions were ICU diary or discharge summary compared with usual care. Feasibility was assessed throughout the study process, and acceptability assessed 3 and 6 months after hospital discharge, with data analysed descriptively and thematically. RESULTS: Sixty-one patients were recruited; 45 completed 3-month follow-up (74%), and 37 (61%), 6-month follow-up. Participants were medical (39%), surgical (30%), and trauma (31%) patients; aged 55 [interquartile range (IQR): 36-67] years; and stayed in the ICU for 7 [IQR: 3-13] days and hospital for 23 [IQR: 14-32] days. Within the partially randomised framework, 34 patients chose their intervention - four chose usual care, 10 ICU diary, and 20 discharge summary. The remaining 27 patients were randomised - nine usual care, 10 ICU diary, and seven discharge summary. The majority (>90%) considered each intervention helpful during recovery; however, a significant proportion of patients reported distress associated with reading the ICU diary (42%) or discharge summary (15%). Clinicians reported they were hesitant to make diary entries. CONCLUSIONS: When given a choice, more patients chose a discharge summary over the ICU diary or usual care. Participants considered both interventions acceptable. Given the reports of distress associated with information provision, clear empirical evidence is required to determine effectiveness, optimal timing, support needed, and for whom they should be used. CLINICAL TRIAL REGISTRATION NUMBER: ACTRN12615001079538.

The needs of families of trauma intensive care patients: A mixed methods study.

OBJECTIVE: To identify the needs of families of trauma patients in the Intensive Care Unit and to assess nurses' perceptions of those needs. METHODOLOGY: A sequential mixed-methods study was utilised combining survey data and semi-structured interviews. SETTING: A tertiary Intensive Care Unit in Australia. OUTCOME MEASURES: The Critical Care Family Needs Inventory assessed the needs of families of general and trauma patients. Nurses were also surveyed for their perspectives on the needs of trauma patients' families. Interviews with families were analysed using an inductive thematic analysis technique. RESULTS/FINDINGS: 214 surveys were completed (50 family members of trauma patients; 53 family members of general patients; 111 nurses). No statistically significant sub-scale differences in survey responses between the family groups were found. However, differences on four of the five survey sub-scales (p ≤ .001) were identified between families of trauma patients and nurses. Three themes emerged identifying unique needs of families of trauma patients from the interviews and included: Personal Distress and Adjustment,Guidance, and Care. CONCLUSION: This mixed methods study identified that families of trauma patients have different needs to families of general patients and the nurses rated the needs of the families of trauma patients as less important than the families rated their own needs. Through a collaborative partnership with these families, nurses can assist and better meet their needs. The provision of individualised patient/family-centred care is likely to have a positive influence.

The needs of families of ICU trauma patients: an integrative review.

BACKGROUND: The sudden, devastating, nature of traumatic injuries has a profound effect on patients and their families. When family needs are appropriately met in the intensive care units (ICU), families are empowered to support their injured relative (Blom et al., 2013). While the needs of families of general ICU patients have been examined the needs of trauma patients' families are not known and may be unique. AIM: The authors aimed to answer the question: "What are the needs of families of the adult ICU trauma patient?" METHOD: An integrative review methodology was used. RESULTS: Sixteen publications were included from 'traumatic brain injury' and 'burns' trauma subgroups. The themes of 'information'; 'making sense'; 'hope'; 'support'; 'involvement' and 'protection' were identified from the literature. 'Protection' was unique to trauma families, while the other themes concurred with those previously reported for general ICU families. This review was constrained by the lack of focused trauma patients' families' research, and was reliant on traumatic brain injury and burns subgroup studies. How the needs of these subgroups relate to other trauma patients' families is not known, and worthy of further research.

The provision of family-centred intensive care bereavement support in Australia and New Zealand: Results of a cross sectional explorative descriptive survey.

BACKGROUND: Caring for the bereaved is an intrinsic part of intensive care practice with family bereavement support an important aspect of the nursing role at end of life. However, reporting on provision of intensive care family bereavement support at a national level has not been well reported since an Australian paper published ten years ago. OBJECTIVES: The objective was to investigate provision of family bereavement support in intensive care units (ICU) across New Zealand (NZ) and Australia. METHOD: A cross-sectional exploratory descriptive web-based survey was used. All ICUs [public/private, neonatal/pediatrics/adults] were included. The survey was distributed to one nursing leader from each identified ICU (n=229; 188 in Australia, 41 in NZ). Internal validity of the survey was established through piloting. Descriptive statistics were used to analyse the data. Ethical approval was received by the ethics committees of two universities. RESULTS: One-hundred and fifty-three (67%) responses were received from across New Zealand and Australia with 69.3% of respondents from the public sector. Whilst respondents reported common bereavement practices to include debriefing for staff after a traumatic death (87.9%), there was greater variation in sending a sympathy card to families (NZ 54.2%, Australia 20.8%). Fifty percent of responding New Zealand units had a bereavement follow-up service compared to 28.3% of Australian unit respondents. Of those with follow-up services, 92.3% of New Zealand units undertook follow-up calls to families compared to 76.5% of Australian units. Bereavement follow-up services were mainly managed by social workers in Australia and nursing staff in New Zealand. CONCLUSIONS: This is the first Australia and New Zealand-wide survey on ICU bereavement support services. Whilst key components of family bereavement support remain consistent over the past decade, there were fewer bereavement follow-up services in responding Australian ICUs in 2015. As a quality improvement initiative, support for this area of family care remains important with rigorous evaluation essential.

Intensive care bereavement practices across New Zealand and Australian intensive care units: a qualitative content analysis.

BACKGROUND: End-of-life and bereavement care is an important consideration in intensive care. This study describes the type of bereavement care provided in intensive care units across Australia and New Zealand. DESIGN: Inductive qualitative content analysis was conducted on free-text responses to a web-based survey exploring unit-based bereavement practice distributed to nurse managers in 229 intensive care units in New Zealand and Australia. RESULTS: A total of 153 (67%) surveys were returned with 68 respondents making free-text responses. Respondents were mainly Australian (n = 54, 85·3%), from the public sector (n = 51, 75%) and holding Nurse Unit Managers/Charge Nurse roles (n = 39, 52·9%). From the 124 free-text responses, a total of 187 individual codes were identified focussing on bereavement care practices (n = 145, 77·5%), educational provision to support staff (n = 15, 8%) and organisational challenges (n = 27, 14·4%). Bereavement care practices described use of memory boxes, cultural specificity, annual memorial services and use of community support services. Educational provision identified local in-service programmes, and national bereavement courses for specialist bereavement nurse coordinators. Organisational challenges focussed on lack of funding, especially for provision of bereavement follow-up. CONCLUSIONS: This is the first Australasian-wide survey, and one of the few international studies, describing bereavement practices within intensive care, an important aspect of nursing practice. However, with funding for new bereavement services and education for staff lacking, there are continued challenges in developing bereavement care. Given knowledge about the impact of these areas of care on bereaved family members, this requires review. RELEVANCE TO CLINICAL PRACTICE: Nurses remain committed to supporting bereaved families during and following death in intensive care. With limited resource to support bereavement care, intensive care nurses undertake a range of bereavement care practices at time of death, and after death through family bereavement follow-up.

Sleep assessment by patients and nurses in the intensive care: An exploratory descriptive study.

BACKGROUND: Sleep disruption is common in intensive care unit (ICU) patients, with reports indicating reduced quality and quantity of sleep in many patients. There is growing evidence that sleep in this setting may be improved. AIM: To describe ICU patients' self-report assessment of sleep, examine the relationship between patients' self-reported sleep and their reported sleep by the bedside nurse, and describe the strategies suggested by patients to promote sleep. METHODS: An exploratory descriptive study was undertaken with communicative adult patients consecutively recruited in 2014-2015. Patients reported sleep using the Richards-Campbell Sleep Questionnaire (score range 0-100mm; higher score indicates better sleep quality), with nursing assessment of sleep documented across a five level ordinal variable. Patients were asked daily to describe strategies that helped or hindered their sleep. Ethical approval for the study was gained. Descriptive statistical analysis was performed [median (interquartile range)]; relationships were tested using Spearman's rank correlation and differences assessed using the Kruskal-Wallis test; p<0.05 was considered significant. RESULTS: Participants (n=151) were recruited [age: 60 (46-71) years; ICU length of stay 4 (2-9) days] with 356 self-reports of sleep. Median perceived sleep quality was 46 (26-65) mm. A moderate relationship existed between patients' self-assessment and nurses' assessment of sleep (Spearman's rank correlation coefficient 0.39-0.50; p<0.001). Strategies identified by patients to improve sleep included adequate pain relief and sedative medication, a peaceful and comfortable environment and physical interventions, e.g. clustering care, ear plugs. CONCLUSION: Patients reported on their sleep a median of 2 (1-3) days during their ICU stay, suggesting that routine use of self-report was feasible. These reports revealed low sleep quality. Patients reported multiple facilitators and barriers for sleep, with environmental and patient comfort factors being most common. Interventions that target these factors to improve patient sleep should be implemented.