As a nurse, you care not only for the patient in the bed, but for the family of the hospitalized patient. Caring for families whose loved ones are in intensive care carries special challenges as the family members deal with the stress of having their acutely ill loved one occupy a terribly unfamiliar setting filled with complex, off-putting medical devices.
To reduce the stress those families experience, nurses should focus their interventions on valuing the role of family members in patient care, improving communication and providing accurate information, according to the results of research published in the February 2021 issue of Critical Care Nurse.
“Nursing Interventions to Reduce Stress in Families of Critical Care Patients: An Integrative Review” analyzed the literature about family stress in neonatal, pediatric, and adult ICUs. The researchers analyzed the results of 38 studies. They discovered four overall significant stressors: a change in parental role or in family dynamics; the appearance and behavior of the patient; the care setting; and communication and counseling with the healthcare staff. The interventions in each area include:
To reduce stress related to…
- A change in parental role or family dynamics: nurses should allow family members to be present at any time at the patient’s bedside and on the unit.
- The appearance and behavior of the patient: nurses should provide information about specific changes observed and encourage asking questions about them.
- The care setting: nurses should explain the specific features of the setting, providing reassurance that it is normal for family members to require clarification and repetition of information.
- Communication and counseling with the healthcare staff: nurses should establish a communication channel with family members and adapt information to their level of stress and ability to understand the situation.
These interventions relate to the 2017 Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU from the Society of Critical Care Medicine. But this research focuses on the interventions specifically for stress.
Adapting to the family
Unlike other research, this paper groups findings together from neonatal, pediatric, and adult ICUs, instead of looking at each setting separately, notes coauthor Valérie Lebel, Ph.D., RN, professor, Department of Nursing, Université du Québec en Outaouais, Quebec, Canada, herself a neonatal intensive care nurse.
What’s more, previous research typically doesn’t define the concept of “family,” she notes in an interview. “As nurses, you have to adapt your intervention to the type of family,” she says. For instance, a nurse can ensure that a family who might be socioeconomically disadvantaged could have free hospital parking or tickets for a meal. “If you don’t adapt your intervention to your family, it’s really hard to make sure that you really have a partnership with them,” Lebel says.
With COVID, the interventions discovered by the paper, which was done before the pandemic, might be difficult to execute, Lebel notes. “It’s really hard right now to make sure to apply all those interventions,” she says. Still, the nurse needs to find a way to team with the family “no matter what.” If the family cannot be with the patient because of COVID restrictions, the nurse “should find a way to team up with them anyway, to give them information, and to make sure they understand what’s going on.”
Even healthcare professionals may not be aware and prepared for a condition called Post-ICU Syndrome (PICS) that can occur in the aftermath of COVID-19. What about those who were hospitalized for COVID-19, treated in ICU, and are unaware of the possible long-term impact and rehabilitation phase? There is a tendency to think that once the patient is discharged from the hospital, has tested negative, and looks well, the problem is resolved. However, the struggle of COVID-19 survivors and family members or caregivers may not end there.
PICS is an ongoing challenge that may potentially present as a public health crisis. PICS is a term used to describe the group of impairments faced by ICU survivors. It can persist for months or years. PICS encompasses a combination of physical, neurological, social, and psychological decline (Jaffri & Jaffri, 2020). The physical impairments include intensive care acquired weakness, classified as critical illness myopathy, neuropathy, and neuromyopathy. Cognitive and psychological impairments involve impaired memory, language, delirium, depression, anxiety, and post-traumatic stress disorder (Inoue et al., 2019). Especially in COVID-19 ICU patients, some of these impairments are not just because of critical illness, but the invasion of virus in multiple tissues (Papathanassoglou, Manhas, & Kusi-Appiah, 2020).
During the COVID-19 pandemic, critically ill clients are considered the most vulnerable to PICS. Among these, 30% suffer from depression and 70% experience anxiety and post-traumatic stress disorder after ICU discharge (Inoue, et al., 2019). Moreover, survivors can experience additional stress as a result of isolation and limited contact with loved ones/family and reduced contact with staff due to precautionary measures such as personal protective equipment (O’Hanlon & Inouye, 2020). Therefore, every patient suspected of PICS needs early rehabilitation and a formal mental assessment at acute and post-acute phase.
The risk of PICS is not confined to patients. The aftermath of critical illness affects not only ICU survivors but also has a great impact on their families, who may suffer from anxiety, somatic symptoms, stress and complicated grief. Such adverse effects are classified as post ICU syndrome-family (PICS-F) (Inoue et al., 2019). Another challenge PICS clients face is potential financial instability. The majority face difficulty in returning to their usual work, some become jobless and some experience occupational challenges, and the list does not end here. They may encounter extreme difficulties in performing daily living activities and limited mobility, social responsibilities, and interactions (Jaffri & Jaffri, 2020).
So, what can be done to meet the challenge of PICS? Mobilizing an early rehabilitation response is vital. Multidisciplinary teams including nurses, doctors, physiotherapists, occupational therapists, psychologists, nutritionists, and so forth can develop early rehabilitation protocols to curb PICS complications in survivors and increase their functional capacity. COVID-19 survivors may require extensive and prolonged rehabilitation. Some require tertiary rehabilitation centers and others may need community-based care (Papathanassoglou, Manhas, & Kusi-Appiah, 2020). Therefore, an appropriate post-acute care setting is required to address physical, psychological, and cognitive impairments resulting from infection, mechanical ventilation, and prolonged ICU stay. Additionally, to ensure rehabilitation and healthcare professional safety to prevent viral transmission to clients and providers, tele- or virtual rehabilitation facilities need to be initiated early to address impairments encountered by PICS survivors of COVID-19 (Phillips et al. 2020). A comprehensive discharge plan inclusive of immediate needs, goals, interventions, follow-ups, and a comprehensive rehabilitation assessment are strongly recommended to facilitate the diversity of rehabilitation issues and planning of treatment post-hospitalization (Alberta Health Services, 2020). A crucial time has arrived. There is an immediate need to implement tailored care to address PICS related impairments in COVID-19 survivors.
Alberta Health Services (July 17, 2020). COVID-19 Scientific Advisory Group Rapid Evidence Report.
Retrieved from https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-sag-rehabilitation-needs-rapid-review.pdf
Inoue, S., Hatakeyama, J., Kondo, Y., Hifumi, T., Sakuramoto, H., Kawasaki, T., … & Kenmotsu, Y. (2019). Post‐intensive care syndrome: its pathophysiology, prevention, and future directions.
Acute Medicine & Surgery, 6(3), 233-246. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603316/
Jaffri, A., & Jaffri, A. (2020). Post-Intensive Care Syndrome and COVID-19: crisis after a crisis?
Heart & Lung: The Journal of Cardiopulmonary and Acute Care. https://doi.org/10.1016/j.hrtlng.2020.06.006
O’Hanlon, S., & Inouye, S. K. (2020). Delirium: A missing piece in the COVID-19 pandemic puzzle.
Age and Ageing 1-2. doi:10.1093/ageing/afaa094. https://academic.oup.com/ageing/article/49/4/497/5831131
Papathanassoglou, E, Manhas, K. P., & Kusi-Appiah, E. (2020). Beyond acute respiratory distress: Multiple organ effects and early rehabilitation in COVID-19.
Connect: The World of Critical Care Nursing, Vol 13 (4), 1–7. DOI: 10.1891/WFCCN-D-20-00008. https://connect.springerpub.com/content/sgrwfccn/13/4/155
Phillips, M., Turner-Stokes, L., Wade, D., & Walton, K. (2020). Rehabilitation in the wake of COVID-19: A phoenix from the ashes.Accessed on May 12, 2020. Retrieved from https://www.bsrm.org.uk/downloads/covid-19bsrmissue1-published-27-4-2020.pdf
Nurse of the Week is Mady
Howard, an intensive care unit (ICU) nurse at Intermountain Healthcare’s
Dixie Regional Medical Center in St. George, Utah, who says the unpredictable
nature of working in the ICU helped her train to be on ‘American
advanced to the ‘American Ninja Warrior’ finals in Las Vegas during filming in
August, and competed to win the $1 million grand prize. The final four episodes
aired throughout September, and although Howard didn’t win, she says she will
be back for more in the future.
collegiate career as a gymnast helped Howard prepare physically, but she says
the intensity of being an ICU nurse has prepared her mentally for the challenge
of competing on a reality competition show. Contestants aren’t allowed to
practice on the ninja warrior course so their first time on the course is in
front of an audience as they make split-second decisions in high-pressure
situations on an unfamiliar course. To Howard, it feels much like her day-to-day
job in the ICU.
Howard tells modernhealthcare.com, “Life can change so quickly and it motivated me to not stand still and be grateful for every moment I have.”
Finding a passion outside of her demanding 12-hour shifts in the
ICU has also helped Howard become a better healthcare provider. She finds fulfillment
in the training and it makes her a more confident provider for her vulnerable
To learn more about Mady Howard, an ICU nurse who says the
unpredictable nature of working in the ICU helped her train to be on ‘American
Ninja Warrior,’ visit here.
Our Nurse of the Week is Cami
Loritz, an intensive care unit (ICU) nurse from Wisconsin who donated part of
her liver for a transplant
that saved an 8-year-old boy’s life. Loritz is an ICU nurse at Froedtert
Hospital in Wauwatosa, Wisconsin.
The boy’s mother,
Ruth Auten, says she now considers Loritz a part of their family. Auten’s son,
Brayden Auten, was diagnosed with an aggressive
virus that was attacking his liver this past April at the Milwaukee
Children’s Hospital. Brayden’s parents were devastated to learn that their son
was in need of a partial liver transplant.
Desperate to find
a donor, they shared Brayden’s story online. They were flooded with positive
responses, but no one who reached out was a match. Then Loritz showed up, a
perfect match, and Brayden’s doctors immediately moved forward with the
was able to go home in July and is now preparing to return to school as a
healthy 8-year-old. Brayden and Loritz showed off their surgery scars in a
photo shoot, which shows them wearing matching shirts and wide smiles.
Brayden’s parents told People.com, “What she did was completely selfless and she saved his life, plain and simple. We can’t thank her enough. She’s a true miracle. We consider her one of us, one of our family.”
To learn more about Cami Loritz, an ICU
nurse from Wisconsin who donated part of her liver for a transplant that saved
an 8-year-old boy’s life, visit here.
Have you heard about the nurse who clocked out at 6:37PM, signed into a hospital at 7:10PM, and gave birth at 7:28PM. No? Then you don’t know charge nurse, Ashley Chambers. Last week, Chambers worked through her shift at Children’s of Alabama’s Intensive Care Unit before driving over half an hour to give birth to her child.
When Chambers went into labor during her normal shift she chose not to go to the hospital right away because she had other children to tend to – her patients. Focusing on how to make her young patients’ pain go away helped her work through her own labor pains. She had planned to work up until she went into labor, but had no plans of cutting it that close to giving birth. When another charge nurse arrived to take over her shift, she clocked out and was holding her newborn son Riggs Owen in her arms an hour later.
Chambers recalls moments on her drive to the hospital where she thought she might give birth in her car on the highway. However, she finally made it to the hospital and gave birth less than 20 minutes later. Her husband was the only one lucky enough to witness their son’s birth, and only via FaceTime because she gave birth so quickly after arriving at the hospital.
We’ve chosen to honor Ashley Chambers as our Nurse of the Week for her dedication to her job as a nurse. Congratulations to you and your new family.