Learning to manage stress is an important lifestyle change for participants in cardiac rehabilitation programs. Progressive muscle relaxation (PMR) is one stress management approach that has produced positive benefits among different patient populations. The purpose of this study was to identify the effects of learning and practicing PMR in a population of cardiac rehabilitation patients. Blood pressure and heart rate data, and scores on the Spielberger State-Trait Anxiety Inventory (STAI) were collected from a treatment group and a control group of patients enrolled in phases II and III of cardiac rehabilitation. Analysis of the data revealed positive effects of PMR on the variables heart rate and state of anxiety. In addition, written evaluations of PMR from patients in the treatment group indicated a high degree of subjective satisfaction with PMR as a means to reduce stress in their lives.

Background Family members of intensive care unit (ICU) patients are at risk for post–intensive care syndrome– family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. Objectives To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. Methods This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. Results The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. Conclusions The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.

Background Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy. Objective The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients. Methods For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura’s social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study. Results Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022. Conclusions The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial. Trial Registration ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767 International Registered Report Identifier (IRRID) DERR1-10.2196/30813

Aim The purpose of this paper is to conceptually define “caregiver willingness” for application to a family member providing care to a critically ill loved one during an intensive care unit (ICU) hospitalization. Background Delivering care to a family member may have psychological benefits for both the caregiver and the critically ill loved one; however, the willingness of family members to provide care is an elusive concept. Examination of the “caregiver willingness” concept will help to advance nursing science. Design Walker and Avant's eight step strategy guided identification of the defining attributes, empirical referents, antecedents, and consequences of “caregiver willingness.” Data Source Academic Search Complete, CINAHL, MEDLINE, APA PsycInfo, and Psychology and Behavioral Health Collections were used to search for literature published between 2000 and 2020. Review Methods A literature search was conducted using keywords, such as “caregiver,” “willingness,” “willing to care,” “family or families or relatives or siblings or caregiver,” and “critically ill or intensive care or ICU or critical care.” Results A definition of caregiver willingness was constructed and defined as “a family member or significant other's affirmation or acknowledgment of openness to engage in the physical and/or emotional supportive care of a loved one who is critically ill and cannot perform self‐care.” Conclusion The definition provides a foundation for instrument development to measure caregiver willingness and possible theory expansion for family engagement and caregiving in the ICU.

BACKGROUND Family members of critically ill patients suffer symptoms of post-intensive care syndrome-family (PICS-F), including anxiety, depression, and post-traumatic stress disorder. Post-intensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede recovery of the patient. Cognitive behavioral therapy has become a first-line non-pharmacological treatment of psychological symptoms and disorders, including anxiety, depression, and post-traumatic stress. For mild-to-moderate symptoms, mobile technology delivery of cognitive behavioral therapy without input from a clinician has been found to be feasible and well-accepted with efficacy that rivals face-to-face therapy. OBJECTIVE The purpose of this pilot study is to examine the efficacy of smartphone delivery of cognitive behavioral therapy via a mobile health app on the severity and prevalence of PICS-F symptoms in family members of critically ill patients. METHODS For this pilot study, 60 family members of critically ill patients will be recruited. A repeated measures longitudinal design with randomization to two groups (control, intervention) will be employed. The intervention group will receive cognitive behavioral therapy delivered via a smartphone mobile health app. Bandura’s Social Cognition Theory with an emphasis on mental health self-efficacy forms the theoretical framework of the study. RESULTS Recruitment for the study began in August, 2020. Data collection and analysis is expected to be completed by March, 2022. Primary outcome measures will include symptoms of PICS-F (anxiety, depression, post-traumatic stress), health-related quality of life, and mental health self-efficacy measured at enrollment, 30 days after enrollment, and 60 days after enrollment. CONCLUSIONS The proposed study represents a novel approach to the treatment of PICS-F symptoms, is an extension of previous work by the research team, and will be used to plan a fully powered, randomized, controlled trial. CLINICALTRIAL ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767?cond=Post-Intensive+Care+Syndrome&draw=3&rank=17