Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599-7025, USA.
Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Neurocrit Care. 2024 Apr;40(2):674-688. doi: 10.1007/s12028-023-01804-3. Epub 2023 Jul 31.
Family caregivers of patients with severe acute brain injury (SABI) admitted to intensive care units (ICUs) with coma experience heightened emotional distress stemming from simultaneous stressors. Stress and coping frameworks can inform psychosocial intervention development by elucidating common challenges and ways of navigating such experiences but have yet to be employed with this population. The present study therefore sought to use a stress and coping framework to characterize the stressors and coping behaviors of family caregivers of patients with SABI hospitalized in ICUs and recovering after coma.
Our qualitative study recruited a convenience sample from 14 US neuroscience ICUs. Participants were family caregivers of patients who were admitted with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, or hypoxic-ischemic encephalopathy; had experienced a comatose state for > 24 h; and completed or were scheduled for tracheostomy and/or gastrostomy tube placement. Participants were recruited < 7 days after transfer out of the neuroscience ICU. We conducted live online video interviews from May 2021 to January 2022. One semistructured interview per participant was recorded and subsequently transcribed. Recruitment was stopped when thematic saturation was reached. We deductively derived two domains using a stress and coping framework to guide thematic analysis. Within each domain, we inductively derived themes to comprehensively characterize caregivers' experiences.
We interviewed 30 caregivers. We identified 18 themes within the two theory-driven domains, including ten themes describing practical, social, and emotional stressors experienced by caregivers and eight themes describing the psychological and behavioral coping strategies that caregivers attempted to enact. Nearly all caregivers described using avoidance or distraction as an initial coping strategy to manage overwhelming emotions. Caregivers also expressed awareness of more adaptive strategies (e.g., cultivation of positive emotions, acceptance, self-education, and soliciting social and medical support) but had challenges employing them because of their heightened emotional distress.
In response to substantial stressors, family caregivers of patients with SABI attempted to enact various psychological and behavioral coping strategies. They described avoidance and distraction as less helpful than other coping strategies but had difficulty engaging in alternative strategies because of their emotional distress. These findings can directly inform the development of additional resources to mitigate the long-term impact of acute psychological distress among this caregiver population.
入住重症监护病房（ICU）并处于昏迷状态的严重急性脑损伤（SABI）患者的家属经历了同时存在的压力源，导致情绪困扰加剧。压力和应对框架可以通过阐明常见的挑战和应对这些经历的方式来为心理社会干预的发展提供信息，但尚未在这一人群中使用。因此，本研究旨在使用压力和应对框架来描述 SABI 患者家属的压力源和应对行为，这些患者在 ICU 住院并从昏迷中恢复。
我们的定性研究从美国 14 个神经科学 ICU 中招募了一个方便样本。参与者是因缺血性中风、脑出血、蛛网膜下腔出血、创伤性脑损伤或缺氧缺血性脑病而入院的患者的家属；昏迷状态超过 24 小时；并完成或计划进行气管造口术和/或胃造口术。参与者在从神经科学 ICU 转出后不到 7 天被招募。我们于 2021 年 5 月至 2022 年 1 月进行现场在线视频访谈。每位参与者进行一次半结构化访谈并记录，随后进行转录。当主题达到饱和时，招募就停止了。我们使用压力和应对框架推导出两个领域，以指导主题分析。在每个领域内，我们归纳出主题，全面描述护理人员的体验。
我们采访了 30 名护理人员。我们在两个理论驱动的领域中确定了 18 个主题，包括描述护理人员经历的实际、社会和情绪压力源的 10 个主题，以及描述护理人员试图实施的心理和行为应对策略的 8 个主题。几乎所有的护理人员都描述了最初使用回避或分散注意力作为应对压倒性情绪的策略。护理人员还表示意识到更适应的策略（例如，培养积极情绪、接受、自我教育以及寻求社会和医疗支持），但由于他们情绪困扰加剧，他们在实施这些策略方面存在挑战。
针对严重的压力源，SABI 患者的家属尝试实施各种心理和行为应对策略。他们描述回避和分散注意力不如其他应对策略有用，但由于情绪困扰，他们难以采用替代策略。这些发现可以直接为减轻这一护理人员群体急性心理困扰的长期影响提供额外资源的开发。
