Opinions of families, staff, and patients about family participation in care in intensive care units.

PURPOSE: The aims of the study were to assess opinions of caregivers, families, and patients about involvement of families in the care of intensive care unit (ICU) patients; to evaluate the prevalence of symptoms of anxiety and depression in family members; and to measure family satisfaction with care. MATERIALS AND METHODS: Between days 3 and 5, perceptions by families and ICU staff of family involvement in care were collected prospectively at a single center. Family members completed the Hospital Anxiety and Depression Scale (HADS) and a satisfaction scale (Critical Care Family Needs Inventory). Nurses recorded care provided spontaneously by families. Characteristics of patient-relative pairs (n = 101) and ICU staff (n = 45) were collected. Patients described their perceptions of family participation in care during a telephone interview, 206 ± 147 days after hospital discharge. RESULTS: The numbers of patient-relative pairs for whom ICU staff reported favorable perceptions were 101 (100%) of 101 for physicians, 91 (90%) for nurses, and 95 (94%) for nursing assistants. Only 4 (3.9%) of 101 families refused participation in care. Only 14 (13.8%) of 101 families provided care spontaneously. The HADS score showed symptoms of anxiety in 58 (58.5%) of 99 and of depression in 26 (26.2%) of 99 family members. The satisfaction score was high (11.0 ± 1.25). Among patients, 34 (77.2%) of 44 had a favorable perception of family participation in care. CONCLUSIONS: Families and ICU staff were very supportive of family participation in care. Most patients were also favorable to care by family members.

Effects of an alert system on implantable cardioverter defibrillator-related anxiety: rationale, design, and endpoints of the PANORAMIC multicentre trial.

AIMS: Implantable cardioverter defibrillators (ICD) can prevent sudden cardiac death by delivering high-energy shocks in patients at risk of life-threatening ventricular tachyarrhythmias. Patients may be anxious about receiving inappropriate shocks in case of device or lead system malfunction, or about failing to receive needed therapy for the same reason. New devices include programmable vibrating patient notifiers (PN), which, by warning patients of a possible device dysfunction, might lower device-related anxiety. PAtient NOtifier feature for Reduction of Anxiety: a Multicentre ICD study (PANORAMIC) is a multicentre, randomized, clinical trial designed to examine the effects of the awareness of an active vibrating alert system on device-related anxiety. METHODS: The trial will randomly assign 356 patients in a 1:1 design to a control group (PN OFF) vs. a treatment group (PN ON). Patients will be followed for 12 months, with visits scheduled at 6 and 12 months. During clinical follow-up visits, the ICD will be interrogated, and all patients will complete the Hospital Anxiety and Depression Scale and a device-related anxiety questionnaire. The sensitivity and specificity of PN, the effect of personality on anxiety, using the Type D scale (DS14), the number of delivered appropriate and inappropriate ICD therapies, changes in anxiety related to the delivery of appropriate or inappropriate shocks, crossovers from the assigned group, the number of hospitalizations, and the mortality rate will also be assessed. ClinicalTrials.gov Identifier: NCT00559559.

Quality of life in patients aged 80 or over after ICU discharge.

INTRODUCTION: Our objective was to describe self-sufficiency and quality of life one year after intensive care unit (ICU) discharge of patients aged 80 years or over. METHODS: We performed a prospective observational study in a medical-surgical ICU in a tertiary non-university hospital. We included patients aged 80 or over at ICU admission in 2005 or 2006 and we recorded age, admission diagnosis, intensity of care, and severity of acute and chronic illnesses, as well as ICU, hospital, and one-year mortality rates. Self-sufficiency (Katz Index of Activities of Daily Living) was assessed at ICU admission and one year after ICU discharge. Quality of life (WHO-QOL OLD and WHO-QOL BREF) was assessed one year after ICU discharge. RESULTS: Of the 115 consecutive patients aged 80 or over (18.2% of admitted patients), 106 were included. Mean age was 84 +/- 3 years (range, 80 to 92). Mortality was 40/106 (37%) at ICU discharge, 48/106 (45.2%) at hospital discharge, and 73/106 (68.9%) one year after ICU discharge. In the 23 patients evaluated after one year, self-sufficiency was unchanged compared to the pre-admission status. Quality of life evaluations after one year showed that physical health, sensory abilities, self-sufficiency, and social participation had slightly worse ratings than the other domains, whereas social relationships, environment, and fear of death and dying had the best ratings. Compared to an age- and sex-matched sample of the general population, our cohort had better ratings for psychological health, social relationships, and environment, less fear of death and dying, better expectations about past, present, and future activities and better intimacy (friendship and love). CONCLUSIONS: Among patients aged 80 or over who were selected at ICU admission, 80% were self-sufficient for activities of daily living one year after ICU discharge, 31% were alive, with no change in self-sufficiency and with similar quality of life to that of the general population matched on age and sex. However, these results must be interpreted cautiously due to the small sample of survivors.

Perceptions of a 24-hour visiting policy in the intensive care unit.

OBJECTIVE: To examine perceptions by intensive care unit (ICU) workers of unrestricted visitation, to measure visiting times, and to determine prevalence of symptoms of anxiety and depression in family members. DESIGN: Observational, prospective, single-center cohort. SETTING: Medical-surgical ICU in a 460-bed tertiary-care hospital. PATIENTS: Two hundred nine consecutive patients hospitalized >3 days were studied over the first 5 ICU days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Characteristics of patients (n = 209), families (n = 149), and ICU workers (n = 43) were collected. ICU workers reported their perceptions of unrestricted visitation, and family members completed the Hospital Anxiety and Depression Scale. Daily severity scores (Simplified Acute Physiology Score II and Logistic Organ Failure) and a workload score (Nine Equivalents of Nursing Manpower) were computed. Maximum median visit length was 120 mins per patient per day and occurred on days 4 and 5. No correlations were found among severity of illness, workload, and visit length. For 115 patients, both nurse and physician questionnaires were available; although several differences were noted, neither nurses nor physicians perceived open visitation as disrupting patient care. The median rating for delay in organizing care was "never" for physicians and "occasionally" for nurses. Nurses perceived more disorganization of care than physicians (p = .008). Compared with nurses, the physicians reported greater family trust (p = .0023), more family stress (p = .047), and greater unease when examining the patient (p = .02). The Hospital Anxiety and Depression Scale indicated symptoms of anxiety in 73 (49%) family members and depression in 44 (29.5%). CONCLUSIONS: The 24-hr visitation policy was perceived favorably by families. It induced only moderate discomfort among ICU workers, due to the potential for care interruption, in particular for nurses.