Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic

Abstract

Background Support for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences. Methods We performed a cross-sectional multicentre cohort study in six Dutch ICUs in the Netherlands. Written questionnaires were distributed among relatives of ICU patients from pre-COVID-19, the first wave and the second wave. The questionnaire included questions on demographics, the organisation of support, and the experiences and satisfaction of relatives with the support. Results A total of 329 relatives completed the questionnaire (52% partner, 72% woman and 63% ICU stay of 11 days or longer). Support for relatives of ICU patients during the first COVID-19 wave differed significantly from pre-COVID-19 and the second wave. Differences were found in all categories of elements of support: who, when, how and what. Overall, relatives from the three time periods were very positive about the support. The only difference in satisfaction between the three time periods, was the higher proportion of relatives indicating that healthcare professionals had enough time for them during the first wave. Elements of support which were associated with many positive experiences and satisfaction were: fixed timeslot, receiving information (e.g. leaflets) on ≥ 2 topics, discussing > 5 topics with healthcare professionals, and being offered emotional support. Conclusions Although, support for relatives in the ICU changed considerably during the COVID-19 pandemic, relatives were still positive about this support. The altered support gave insight into avenues for improvement for future comparable situations as well as for normal daily ICU practice: e.g. daily contact at a fixed timeslot, offering video calling between patients and relatives, and offering emotional support. ICUs should consider which elements need improvement in their practice.

Reducing Undue Burden on Nurses Related to Limited Care Partner Visitation

“…Family support teams reprieved nurses of the time needed for effective care partner support. These findings are consistent with other recommendations that FSTs or nurse liaisons can mitigate nurse distress when visitation is limited 21 …”

“…These findings are consistent with other recommendations that FSTs or nurse liaisons can mitigate nurse distress when visitation is limited. 21 Similarly, many studies demonstrate that the teamwork and solidarity experienced by nurses during periods of restricted visitation were emotionally protective. 8,22 Family support teams and nurse liaisons, often composed of redeployed procedural nurses, leverage the cohesion and support that are known to reduce burnout and stress in nurses.…”

Effects of person-centred care and intensive care experience on post-intensive care syndrome in critical care survivors: a multi-centre prospective cohort study

“…Kang et al's [28] meta-analysis identi ed family participation, information provision, lighting and noise blocking as effective in preventing delirium, which can all be classi ed as PCC interventions. Recent studies [29,30] have reported that virtual visiting or video calling to replace visiting restrictions during the COVID-19 pandemic was effective in preventing delirium and reducing psychological distress in ICU patients. Despite these encouraging outcomes, a meta-analysis found insu cient evidence of signi cant effects of PCC interventions on post-discharge mental health and ICU delirium [25].…”

Experiences with and needs for aftercare following the death of a loved one in the ICU: a mixed-methods study among bereaved relatives

“…It combined a retrospective questionnaire study with a subsequent qualitative in-depth semi-structured interview study. This study is part of a larger study among relatives of ICU patients, both discharged and deceased, which also addressed other topics such as important elements of support [ 20 ] and treatment decision-making [ 21 ]. As the current study is about aftercare for bereaved relatives, only data from relatives of ICU patients who died in the ICU were included.…”

“…During the first COVID-19 wave, three of the six ICUs used newly developed family support teams, which consisted of non-ICU healthcare professionals, who supported relatives via telecommunication. In the other three ICUs, healthcare professionals from the ICU continued to provide the support themselves, but also via telecommunication [ 20 ].…”