College of Nursing.
Critical Care Division, Nebraska Medicine, Omaha, Nebraska.
Ann Am Thorac Soc. 2022 Nov;19(11):1881-1891. doi: 10.1513/AnnalsATS.202106-651OC.
There has been a paradigm shift to partner with family caregivers by actively involving them in the direct care of the patient throughout the critical illness trajectory. Before effectively engaging family members in patient care, clinicians must assess characteristics and circumstances that may affect caregiver readiness to assume a caregiving role in the intensive care unit (ICU). To determine how demographic, clinical, and psychological factors are related to characteristics of family caregiver readiness to engage in ICU patient care. A convenience sample of ICU family caregivers of both adult and pediatric patients in the ICU was recruited for this cross-sectional study. Participants completed the following measures: PROMIS-29 (Patient-Reported Outcomes Measurement and Information System); HADS (Hospital Anxiety and Depression Scale); CaSES (Caregiver Self-Efficacy Scale); Prep Scale (Preparedness for Caregiving Scale); Patient Activation Measure for Caregivers; and FCMFHS (Family Caregiver's Motives for Helping Scale). Data were collected via self-report at a single time point while the caregiver was visiting the critically ill patient in the ICU. Data analysis consisted of descriptive statistics and bivariate correlations. Caregivers ( = 127) were primarily White (82.7%), females (77.2%), with a mean age of 51.8 (standard deviation [SD], 15.6). Most were either spouses (37.8%) or parents (32.3%) of the patient in the ICU. Patients were primarily adult (76.4%) with a mean APACHE (Acute Physiology, Age, Chronic Health Evaluation) III of 45.9 (SD, 22.5). There were significant ( < 0.05) negative correlations between depression, anxiety, and fatigue and all subscales of self-efficacy (resilience r = -0.18 to -0.30; self-maintenance r = -0.44 to -0.63; emotional connectivity r = -0.27 to -0.41; instrumental giving r = -0.34 to -0.46). Caregiver depression was negatively correlated with caregiver activation (r = -0.199) and caregiver preparedness (r = -0.300). Social satisfaction was positively correlated ( < 0.05) with caregiving preparedness, motivation, and all subscales of self-efficacy (preparedness r = 0.19; motivation r = 0.24; resilience r = 0.21; self-maintenance r = 0.49; emotional connectivity r = 0.29; instrumental giving r = 0.36). We found that caregiver symptoms of depression, anxiety, and fatigue are inversely related to caregiver preparation, motivation, and self-efficacy. To develop effective interventions for ICU family caregivers, further research is needed to understand the relationship between caregiver well-being, caregiving readiness, and caregiver involvement in patient care.
已经出现了一种范式转变,即通过积极让家庭成员在整个危重病患者的病程中直接参与患者的护理,与家庭护理人员合作。在有效地让家庭成员参与患者护理之前,临床医生必须评估可能影响护理人员在重症监护病房(ICU)中承担护理角色的准备情况的特征和情况。为了确定人口统计学、临床和心理因素与家庭护理人员准备参与 ICU 患者护理的特征之间的关系。本横断面研究招募了 ICU 内成人和儿科患者的 ICU 家庭护理人员的便利样本。参与者完成了以下措施:PROMIS-29(患者报告的结果测量和信息系统);HADS(医院焦虑和抑郁量表);CaSES(护理人员自我效能量表);准备量表(护理准备量表);患者为护理人员激活量表;以及 FCMFHS(家庭护理人员帮助量表)。数据是在护理人员在 ICU 中探视危重病人时通过自我报告收集的。数据分析包括描述性统计和双变量相关性。护理人员( = 127)主要是白人(82.7%),女性(77.2%),平均年龄为 51.8(标准差[SD],15.6)。他们中的大多数人是 ICU 中患者的配偶(37.8%)或父母(32.3%)。患者主要是成人(76.4%),急性生理学、年龄、慢性健康评估(APACHE)III 平均为 45.9(SD,22.5)。抑郁、焦虑和疲劳与自我效能的所有分量表之间存在显著( < 0.05)负相关(韧性 r = -0.18 至 -0.30;自我维持 r = -0.44 至 -0.63;情感连接 r = -0.27 至 -0.41;工具性给予 r = -0.34 至 -0.46)。护理人员的抑郁与护理人员的激活(r = -0.199)和护理人员的准备(r = -0.300)呈负相关。社会满意度与护理准备、动机和自我效能的所有分量表呈正相关( < 0.05)(准备 r = 0.19;动机 r = 0.24;韧性 r = 0.21;自我维持 r = 0.49;情感连接 r = 0.29;工具性给予 r = 0.36)。我们发现,护理人员的抑郁、焦虑和疲劳症状与护理人员的准备、动机和自我效能呈负相关。为了为 ICU 家庭护理人员制定有效的干预措施,需要进一步研究以了解护理人员的幸福感、护理准备情况和护理人员参与患者护理之间的关系。