Garrouste-Orgeas Maité, Max Adeline, Lerin Talia, Grégoire Charles, Ruckly Stéphane, Kloeckner Martin, Brochon Sandie, Pichot Emmanuelle, Simons Clara, El-Mhadri Myriame, Bruel Cédric, Philippart François, Fournier Julien, Tiercelet Kelly, Timsit Jean-François, Misset Benoit
1Medical-Surgical ICU, Saint Joseph Hospital Network, 75014 Paris, France. 2Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, - Bichat University Hospital, University, Sorbonne Paris Cité, F-75018 Paris, France. 3Department of Biostatistics, Outcomerea, Paris, France. 4Medical ICU, Bichat Teaching Hospital, Paris, France. 5Paris Descartes University, UFR de Médecine, 75006 Paris, France.
Crit Care Med. 2016 Jun;44(6):1116-28. doi: 10.1097/CCM.0000000000001632.
To investigate family perceptions of having a nurse participating in family conferences and to assess the psychologic well being of the same families after ICU discharge.
Mixed-method design with a qualitative study embedded in a single-center randomized study.
Twelve-bed medical-surgical ICU in a 460-bed tertiary hospital.
One family member for each consecutive patient who received more than 48 hours of mechanical ventilation in the ICU.
Planned proactive participation of a nurse in family conferences led by a physician. In the control group, conferences were led by a physician without a nurse.
Of the 172 eligible family members, 100 (60.2%) were randomized; among them, 88 underwent semistructured interviews at ICU discharge and 86 completed the Peritraumatic Dissociative Experiences Questionnaire at ICU discharge and then the Hospital Anxiety Depression Questionnaire and the Impact of Event Scale (for posttraumatic stress-related symptoms) 3 months later. The intervention and control groups were not significantly different regarding the prevalence of posttraumatic stress-related symptoms (52.3 vs 50%, respectively; p = 0.83). Anxiety and depression subscale scores were significantly lower in the intervention group. The qualitative data indicated that the families valued the principle of the conference itself. Perceptions of nurse participation clustered into four main themes: trust that ICU teamwork was effective (50/88; 56.8%), trust that care was centered on the patient (33/88; 37.5%), trust in effective dissemination of information (15/88; 17%), and trust that every effort was made to relieve anxiety in family members (12/88; 13.6%).
Families valued the conferences themselves and valued the proactive participation of a nurse. These positive perceptions were associated with significant anxiety or depression subscale scores but not with changes in posttraumatic stress-related symptoms.
调查家属对于护士参与家庭会议的看法，并评估这些家庭在重症监护病房（ICU）出院后的心理健康状况。
单中心随机研究中嵌入定性研究的混合方法设计。
一家拥有460张床位的三级医院中的12张床位的内科-外科重症监护病房。
在ICU接受超过48小时机械通气的每位连续患者的一名家庭成员。
由护士计划主动参与由医生主持的家庭会议。在对照组中，会议由医生主持，无护士参与。
172名符合条件的家庭成员中，100名（60.2%）被随机分组；其中，88名在ICU出院时接受了半结构化访谈，86名在ICU出院时完成了创伤周围分离体验问卷，然后在3个月后完成了医院焦虑抑郁问卷和事件影响量表（用于创伤后应激相关症状）。干预组和对照组在创伤后应激相关症状的患病率方面无显著差异（分别为52.3%和50%；p = 0.83）。干预组的焦虑和抑郁子量表得分显著更低。定性数据表明，家属重视会议本身的原则。对护士参与的看法主要集中在四个主题：信任ICU团队协作有效（50/88；56.8%）、信任护理以患者为中心（33/88；37.5%）、信任信息有效传播（15/88；17%）以及信任尽一切努力缓解家属焦虑（12/88；13.6%）。
家属重视会议本身以及护士的主动参与。这些积极看法与焦虑或抑郁子量表得分显著相关，但与创伤后应激相关症状的变化无关。
