Effect of a Standardized Family Participation Program in the ICU: A Multicenter Stepped-Wedge Cluster Randomized Controlled Trial

被引：12

作者：

Dijkstra, Boukje M. ^{[1
,2
]}

Rood, Paul J. T. ^{[1
,2
]}

Teerenstra, Steven ^{[3
]}

Rutten, Anne M. F. ^{[4
]}

Leerentveld, Crista ^{[5
]}

Burgers-Bonthuis, Dominique C. ^{[6
]}

Festen-Spanjer, Barbara ^{[7
]}

Klarenbeek, Toine ^{[8
]}

Van Den Boogaard, Mark ^{[2
]}

Ewalds, Esther ^{[9
]}

Schoonhoven, Lisette ^{[10
,11
]}

Van Der Hoeven, Johannes G. ^{[2
]}

Vloet, Lilian C. M. ^{[1
,12
,13
]}

机构：

[1] HAN Univ Appl Sci, Sch Hlth Studies Nijmegen, Res Dept Emergency & Crit Care, Nijmegen, Netherlands

[2] Radboud Univ Nijmegen, Dept Intens Care Med, Med Ctr, Nijmegen, Netherlands

[3] Radboud Univ Nijmegen, Med Ctr, Dept Hlth Evidence, Sect Biostat, Nijmegen, Netherlands

[4] Elisabeth Tweesteden Hosp, Dept Intens Care Med, Tilburg, Netherlands

[5] ISALA Hosp, Dept Intens Care Med, Zwolle, Netherlands

[6] Hosp Rijnstate, Dept Intens Care Med, Arnhem, Netherlands

[7] Hosp Gelderse Vallei, Dept Intens Care Med, Ede, Netherlands

[8] Maxima Med Ctr, Dept Intens Care Med, Veldhoven, Netherlands

[9] Bernhoven, Dept Intens Care Med, Uden, Netherlands

[10] Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Nursing Sci, Utrecht, Netherlands

[11] Univ Southampton, Fac Environm & Life Sci, Sch Hlth Sci, Southampton, Hants, England

[12] Radboud Univ Nijmegen, Med Ctr, Radboud Inst Hlth Sci, IQ Healthcare, Nijmegen, Netherlands

[13] Fdn Family & Patient Ctr Intens Care, Alkmaar, Netherlands

来源：

CRITICAL CARE MEDICINE | 2024年 / 52卷 / 03期

关键词：

anxiety; critical care; depression; essential care; family-centered care; family participation; intensive care unit; nursing; post-intensive care syndrome; posttraumatic stress disorder; relatives; satisfaction; POSTTRAUMATIC-STRESS-DISORDER; HOSPITAL ANXIETY; CENTERED CARE; IMPACT; INVOLVEMENT; SURVIVORS; OPINIONS; INJURY; COHORT;

D O I：

10.1097/CCM.0000000000006093

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

OBJECTIVES:To determine the effect of a standardized program for family participation in essential care activities in the ICU on symptoms of anxiety, depression, posttraumatic stress and satisfaction among relatives, and perceptions and experiences of ICU healthcare providers (HCPs). DESIGN:Multicenter stepped-wedge cluster randomized controlled trial. SETTING:Seven adult ICUs, one university, and six general teaching hospitals. PARTICIPANTS:Three hundred six relatives and 235 ICU HCPs. INTERVENTIONS:A standardized program to facilitate family participation inpatient communication, amusement/distraction, comfort, personal care, breathing, mobilization, and nutrition. MEASUREMENTS AND MAIN RESULTS:Data were collected through surveys among relatives and ICU HCPs. There were no significant differences in symptoms of anxiety in relatives in the intervention period compared with the control period (median Hospital Anxiety and Depression Scale [HADS] 5 [interquartile range (IQR) 2-10] vs 6 [IQR 3-9]; median ratio [MR] 0.72; 95% CI, 0.46-1.13; p = 0.15), depression (median HADS 4 [IQR 2-6] vs 3 [IQR 1-6]; MR 0.85; 95% CI, 0.55-1.32; p = 0.47) or posttraumatic stress (median Impact of Event Scale-Revised score 0.45 [IQR 0.27-0.82] vs 0.41 [IQR 0.14-1]; MR 0.94; 95% CI, 0.78-1.14; p = 0.54). Reported satisfaction was slightly lower in the intervention period (mean 8.90 [sd 1.10] vs mean 9.06 [sd 1.10], difference -0.60; 95% CI, -1.07 to -0.12; p = 0.01). ICU HCPs perceived that more relatives knew how to participate: 47% in the intervention period versus 22% in the control period (odds ratio [OR] 3.15; 95% CI, 1.64-6.05; p < 0.01). They also reported relatives having sufficient knowledge (41% vs 16%; OR 3.56; 95% CI, 1.75-7.25; p < 0.01) and skills (44% vs 25%; OR 2.38; 95% CI, 1.22-4.63; p = 0.01) to apply family participation. CONCLUSIONS:Application of a standardized program to facilitate family participation did not change mental health symptoms in relatives of ICU patients 3 months after discharge. ICU HCPs reported increased clarity, knowledge, and skills among relatives and ICU HCPs.

引用

页码：420 / 431

页数：12

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