Outcomes and experiences of relatives of patients discharged home after critical illness: a systematic integrative review

Abstract

Background Patients discharged from intensive care may experience psychological and physical deficits resulting in a long and complex rehabilitation upon discharge. Relatives are also vulnerable to psychological pathologies and diminished health‐related quality of life following the patients' critical illness. Relatives often provide care during the patients' rehabilitation, which may influence their health. Aim To report the outcomes and experiences of relatives of patients discharged home after critical illness. Design Systematic integrative review. Methods Electronic databases Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase®, and PsychINFO® were searched using keywords, synonyms, and medical subject headings. Reference lists of articles and critical care journals were manually searched. Studies eligible for inclusion reported primary research and were published in English between 2007 and 2017. Studies were appraised using the Critical Appraisal Skills Programme checklists. Data were extracted and then analysed according to framework. Findings Twenty‐five studies were included: 19 quantitative, 4 qualitative, and 1 mixed method study. Three themes were identified: health and well‐being, employment and lifestyle, and caregiving role. Health and well‐being reports the incidence and significance of psychological morbidity such as post‐traumatic stress disorder, anxiety, and depression. Employment and lifestyle describes the impact of caregiving on the relative's ability to work and engage in usual social activities. The final theme describes and discusses the caregiving role in terms of activities of daily living, knowledge and skills, and adaption to the role. Conclusions There is a significant and meaningful impact on outcomes and experiences of relatives of patients discharged home after critical illness. Relatives' caregiving is embedded within the context of their psychological morbidity and social adjustment. Relevance to practice If informal care giving is to be sustainable, there is a need to design effective strategies of supporting families through all stages of the critical illness trajectory.

Family Caregiver Preferences and Contributions Related to Patient Care in the ICU

“…The majority of patients who survive a critical illness require significant help with activities of daily living and depend on family caregivers for support. While family caregivers have identified positive aspects of their ICU caregiving experience (Tate & Choi, 2020), they are often unprepared to assume burdensome caregiving responsibilities after the patient returns home (Choi et al, 2018; Levine & Reinhard, 2016; Stayt & Venes, 2019). Ongoing caregiving responsibilities can have persistent negative effects on caregivers’ quality of life (Cameron et al, 2016; Choi et al, 2011; Douglas & Daly, 2003; Hickman & Douglas, 2010).…”

Visitor’s Experiences of an Evidence-Based Designed Healthcare Environment in an Intensive Care Unit

“…Previous studies have found that when pleasantness was perceived as high, the environment was also perceived as safe, secure, and stimulating (Bengtsson & Carlsson, 2006;Shih & Ramilo, 2014). Previous research has reported that families of critically ill patients cared for in ICUs experience serious types of ill-being such as depression, anxiety, and fatigue (Apple, 2014;Celik et al, 2016;Day et al, 2013); sometimes, they even develop post-traumatic stress disorder (Petrinec & Daly, 2016;Stayt & Venes, 2019;Wintermann et al, 2016). These findings from the refurbished intervention room can be a way of reducing some elements of ill-being.…”

Family Health Conversations create awareness of family functioning

“…A healthy family function may be facilitated by health professionals supporting the family during the ICU stay while following proper guidelines . There is a need to design strategies to support families throughout all stages of critical illness . The intervention does not exclude individual support for the family members.…”

“…31,32 There is a need to design strategies to support families throughout all stages of critical illness. 33…”