To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge. DESIGN:A prospective, multicenter, randomized clinical trial. SETTING: Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals. PATIENTS:Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge. INTERVENTION:The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward. MEASUREMENTS AND RESULTS:Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG (n = 91) and CG (n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression (p < 0.001) and the presence of depression (p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes. CONCLUSIONS:We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials.TRIAL REGISTRATION: NCT04527627 (https://clinicaltrials.gov/ct2/show/ NCT04527627).
Background: Intensive care unit (ICU) patients can experience emotional distress and post-traumatic stress disorder when they leave the ICU, also referred to as post-intensive care syndrome. A deeper understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient-centred care and, ultimately, contribute to a positive experience.Aim: To describe the patients' experience while transitioning from the ICU to a general ward.Design: A descriptive qualitative study.Method: Data were gathered through in-depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.Findings: Forty-eight interviews were conducted. Impact on emotional well-being emerged as a main theme, comprising four categories with six subcategories. Conclusion:Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well-being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward.Relevance to clinical practice: It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow-up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge.
Aim: (a) To understand patients' lived experience at intensive care unit (ICU) discharge and (b) to evaluate the impact of a nursing empowerment intervention (NEI) on patients' anxiety and depression levels at ICU discharge.Design: A mixed-methods approach will be applied. Methods:In the qualitative phase, the hermeneutic phenomenological method will be used. Participants will be patients from three university hospitals who will be selected by purposive sampling. Data will be gathered through in-depth interviews and analysed using content analysis. The qualitative data obtained will be employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group will be used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale (HADS). Simple random probabilistic sampling will include 172 patients in this phase.
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