The effect of postintensive care syndrome on the quality of life of intensive care unit survivors: A secondary analysis

BackgroundDespite increasing interest in postintensive care syndrome and the quality of life of intensive care unit survivors, the empirical literature on the relationship between these two variables is limited.ObjectivesThis study aimed to examine whether postintensive care syndrome predicts the quality of life of intensive care unit survivors.MethodsWe analysed secondary data, which were collected as part of a larger cross-sectional study. The participants were recruited from six health institutions in Korea. The data of 496 survivors who had been admitted to an intensive care unit for at least 48 h during the past year were analysed. They responded to measures of postintensive care syndrome and quality of life.ResultsThe participants' mean physical and mental component summary scores (quality of life) were 40.08 ± 8.99 and 40.24 ± 11.19, respectively. Physical impairment (β = ?0.48, p < 0.001), unemployment (β = ?0.19, p < 0.001), low income (β = ?0.11, p = 0.004), older age (β = ?0.08, p = 0.039), and cognitive impairment (β = ?0.11, p = 0.045) predicted lower physical component summary scores. Mental (β = ?0.49, p < 0.001) and cognitive impairment (β = ?0.14, p = 0.005) and low income (β = ?0.09, p = 0.014) predicted mental component summary scores.ConclusionsThe participants reported poor physical and mental health–related quality of life. Postintensive care syndrome, unemployment, low income, and older age were the main predictors of poor quality of life. In addition, postintensive care syndrome was a stronger risk factor for poor quality of life than demographic characteristics and intensive care unit treatment factors.     

Perceived control and quality of life among recipients of implantable cardioverter defibrillator

BackgroundPerceived control is strongly associated with health-related quality of life (HRQOL) among patients with chronic conditions, and it is possible to increase perceived control with appropriate intervention. Little is known about the relationship between perceived control and HRQOL in implantable cardioverter defibrillator (ICD) recipients.ObjectivesTo determine the relationship of perceived control with quality of life in ICD recipients and to determine predictors of perceived control in this population.MethodsA total of 263 ICD recipients (63% male, age 61 ± 14 years) completed the Control Attitude Scale-Revised to measure perceived control and completed self-reported measures on potential correlates of perceived control (i.e., depressive symptoms, anxiety, social support, and ICD concerns). The EuroQol-5D was used to measure HRQOL. Regression analysis was used to determine predictors of perceived control and its relationship to HRQOL, controlling for covariates.ResultsLower perceived control (β = 0.30, p < .01), and higher levels of depression (β = −0.30, p < .01) and anxiety (β = −0.18, p < .05) predicted lower levels of HRQOL. Higher anxiety (β = −0.17, p < .05), higher depression (β = −0.23, p < .05), lower social support (β = 0.26, p < .01), and higher ICD-related concerns (β = −0.16, p < .05) independently predicted lower perceived control.ConclusionsInterventions targeting patients' ICD concerns and psychosocial factors before, and continuing after, ICD insertion are needed to improve ICD recipients' perceived control and, in turn, their HRQOL.     

Intra-hospital transfer anxiety of patients in the neurosurgery intensive care unit: A prospective cohort study

BackgroundTransferring a patient from the intensive care unit to different locations within the hospital can cause transfer anxiety. Transfer anxiety is an important factor that adversely affects various physiological and psychological parameters.ObjectiveThe aim of the study is to evaluate the intra-hospital transfer anxiety of patients in a neurosurgery intensive care unit and factors affecting it.MethodsThis prospective cohort study was conducted between November 2021 and June 2022 in a neurosurgery intensive care unit in Istanbul. A total of 171 adult patients who stayed in the intensive care unit for at least 24 h, with a Glasgow Coma Scale score of 14 and above and who had undergone their first intra-hospital transfer were included. Patients’ vital signs were recorded, and their anxiety levels were assessed using the State-Trait Anxiety Inventory.ResultsThe mean age of the patients was 53.16 ± 15.51 years and 56.72% were women, 75.43% of transfers were performed during the day and 64.32% of patients were transferred to an in-patient ward. Factors affecting transfer anxiety were gender, employment status, timing, and purpose of transfer (p < 0.05). Blood pressures and heart rates tended to increase during transfer and decrease again after transfer, while oxygen saturation decreased during transfer (p = 0.035) and increased again after transfer (p < 0.001). State anxiety levels were moderate before transfer and decreased to mild level after transfer (p < 0.001).ConclusionsThe transfer process increased anxiety and caused changes in the vital signs of intensive care patients. Individual and transfer-related factors may influence transfer anxiety. Patients should be monitored for transfer anxiety and nursing interventions to reduce anxiety should be planned.Implications for clinical practiceThe patients’ demographics and transfer details can influence transfer anxiety. Transfer anxiety can affect both subjective parameters and objective measures such as vital signs. Patients at risk of transfer anxiety should be identified before transfers so that nursing interventions to reduce anxiety can therefore be planned.     

Predictors of breastfeeding self-efficacy during the covid-19 pandemic

BackgroundBreastfeeding self-efficacy (BSE) is a strong predictor of the duration of breastfeeding. The aim of this study is to determine the predictors of BSE in breastfeeding mothers during the Covid-19 pandemic.MethodsA cross-sectional study was conducted with 300 breastfeeding mothers who breastfed during the Covid-19 pandemic. Convenience sampling was used to recruit participants. A battery of online questionnaires measured sociodemographic and obstetric characteristics, breastfeeding self-efficacy, spouse postpartum social support, perceived social support, anxiety and depression, and fear of Covid-19. Data were analyzed using Pearson correlation coefficients, one-way ANOVA, and multivariable linear regression via stepwise method. The significance level in this study was α = 0.05.ResultsThe mean BSE score among participants was 58.19 ± 10.48 (out of 70). Spouse postpartum social support (β = 0.732, p = 0.04), intention to breastfeed (β = 0.17, p = 0.001), use of formula while breastfeeding (β = ?0.09, p < 0.001), and depression (β = - 0.11, p < 0.001) were significant predictors of BSE. However, fear of Covid-19 was not significantly correlated with BSE (p = 0.514).ConclusionThe results of the present study showed that fear of Covid-19 was not a significant predictor of BSE, while spouse postpartum social support and having the intention of breastfeeding were positively associated with BSE. Depression and simultaneous use of formula in feeding the infant was negatively associated with BSE during Covid-19. Overall, breastfeeding can be encouraged through counseling to improve receiving spousal support, increasing breastfeeding intent, and reducing depression.     

The effects of a sensory stimulation intervention on psychosocial and clinical outcomes of critically ill patients and their families: A randomised controlled trial

ObjectivesTo explore the effectiveness of a sensory stimulation intervention on intensive care unit patients' psychosocial, clinical, and family outcomes.DesignA prospective, assessor-blind, parallel-group randomised controlled trial.SettingA surgical intensive care unit of one tertiary hospital in Guangzhou, mainland China.InterventionParticipants in the intervention group received a daily 30-minute auditory and visual stimulation session starting from recruitment and for a maximum of seven days while in the intensive care unit.Measurement and main resultsOne hundred fifty-two patients and family caregiver dyads were recruited. Patients in the intervention group showed lower total scores of post-traumatic stress disorder (21.92 ± 6.34 vs 27.62 ± 10.35, p = 0.001), depressive symptoms (3.76 ± 3.99 vs 6.78 ± 4.75, p = 0.001) and delusional memories (0.47 ± 0.92 vs 0.82 ± 1.23, p = 0.001) collected immediately post-intervention than those in the control group, while not on depressive symptoms at one-month post-intervention (3.32 ± 4.03 vs 3.28 ± 3.77, p = 0.800). Sensory stimulation did not significantly impact patients' unit length of stay and 30-day mortality (all p > 0.05). For family outcomes, family caregivers in the intervention group had greater satisfaction with care (127.12 ± 14.14 vs 114.38 ± 21.97, p = 0.001) and a lower level of anxiety (28.49 ± 6.48 vs 34.64 ± 7.68, p = 0.001) than family caregivers in the control group.ConclusionsSensory stimulation may benefit patients' and family caregivers' psychological well-being, and further well-designed multi-centre clustered randomized controlled trials could be considered to strengthen the evidence.     

A comparison of emotional eating,social anxiety and parental attitude among adolescents with obesity and healthy: A case-control study

This case-controlled study was conducted to determine and compare the emotional eating, social anxiety and parental attitude in those adolescents with obesity and healthy counterparts. The sample of the study consist of obese adolescents in 14–18 aged (n = 150) followed up in the pediatric endocrinology outpatient clinic of a tertiary hospital and healthy adolescents in 14–18 aged (n = 150) who were studying in high schools. The data were collected using a questionnaire form, Emotional Eating Scale Adapted to Use in Children and Adolescents (EES-C), Social Anxiety Scale for Children-Revised (SASC-R) and Parenting Style Scale (PSS). The SASC-R and EES-C mean scores of obese adolescents were 39.03 ± 13.09 (p ≤ 0.001) and 76.66 ± 16.30 (p ≤ 0.001), respectively. The mean scores of PSS-AI, PSS-SS and PSS-PA subscales in obese adolescents were 26.80 ± 4.42 (p ≤ 0.001), 28.14 ± 4.06 (p ≤ 0.001) and 22.32 ± 4.63 (p = 0.037), respectively. There was a low-level correlation between the EES-C and SASC-R mean scores of obese adolescents (p < 0.05). The mean scores of PSS-AI, PSS-SS and PSS-PA subscales of PSS with EES-C and SASC-R of obese adolescents were no correlated (p > 0.05). In this study, the mean scores of the emotional eating and social anxiety of obese adolescents were higher than healthy ones. There was a low level of positive correlation between emotional eating and social anxiety mean scores of obese adolescents.     

Family involvement in pregnancy and psychological health among pregnant Black women

Social determinants of health influence psychological health in pregnancy and contribute to health inequities in birth outcomes. This study examines the association between family involvement during pregnancy and psychological health among Black women. Pregnant women in Detroit, MI and Columbus, OH were recruited between 8 and 29 weeks' gestation (n = 203). Higher family involvement was associated with lower depressive symptoms (CES-D; β = ?1.3, p < 0.001), perceived stress (β = ?0.8, p < 0.001), and anxiety (β = ?0.39, p < 0.01), and higher levels of psychological well-being (β = 2.2, p < 0.001). Family involvement may be a protective factor for pregnant Black women.     

Gender and occupational role differences in work-related post-traumatic stress symptoms,burnout and global functioning in emergency healthcare workers

ObjectivesTo explore gender and occupational role impact on work-related Post-Traumatic Stress Symptoms, Post-Traumatic Stress Disorder, burnout and global functioning in a sample of emergency healthcare workers.DesignA cross-sectional study.Participants/setting126 healthcare workers of the Emergency Department, including Intensive Care Unit, Emergency Room and Emergency Medicine, of a major University Hospital in central Italy were recruited.Main outcome measuresParticipants were assessed by means of the: Trauma and Loss Spectrum-Self Report (TALS-SR) to explore Post-Traumatic Stress Spectrum Symptoms, Professional Quality of Life (ProQOL) Scale to assess Compassion Satisfaction, Burnout and Compassion Fatigue and Work and Social Adjustment Scale (WSAS) to measure global functioning.ResultsThe present findings showed females were more prone to develop Post-Traumatic Stress Symptoms, particularly re-experiencing (p = .010) and hyperarousal (p = .026) symptoms and medical doctors reporting higher Burnout (p < .001) and lower Compassion Satisfaction (p = .009) mean scores than nurses. Higher levels of functioning impairment emerged amongst medical doctors rather than nurses, in both social (p = .029) and private (p = .020) leisure activities. Linear correlations highlighted relationships between the TALS-SR, ProQOL and WSAS scores. Finally, medical doctor status was significantly associated with lower Compassion Satisfaction (p = .029) and higher Burnout (p = .015).ConclusionOur results highlight high post-traumatic stress symptoms and burnout levels in emergency healthcare workers with a relevant impact of female gender and occupational role, supporting the need for preventive strategies, also in light of the current COVID-19 pandemic.     

Healthcare professionals’ values about and experience with facilitating end-of-life care in the adult intensive care unit

ObjectivesTo evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs.Research designUsing a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care.SettingGeneral adult intensive care unit at a tertiary referral hospital.ResultsCompared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01).ConclusionFindings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.     

Contribution of alarm noise to average sound pressure levels in the ICU: An observational cross-sectional study

ObjectivesTo explore sound levels, alarm frequencies and the association between alarms and sound levels.DesignA single center observational cross-sectional study.SettingFour intensive care units.Main outcome measuresContribution of alarms: red (life threatening), yellow (indicate excess of limits) and blue (technical) to sound pressure levels dB(A) at nursing stations.ResultsMean sound pressure levels differed significantly between day (56.1 ± 5.5), evening (55.1 ± 5.7) and night periods 53.6 ± 5.6; p < 0.01. 175,996 alarms were recorded of which 149,764 (85%) were yellow, 18,080 (10%) were red and 8,152 (5%) were blue. The mean sound levels without alarms (background) is 56.8 dB(A), with only red: 56.0 dB(A), only yellow: 55.6 dB(A), only blue: 56.0 dB(A) and mixed alarms: 56.3 dB(A). Yellow alarms (b = −0.93; 95% CI: −1.26 to −0.6; p < 0.001) were weakly but significantly associated with mean sound levels and lead to a slight decrease in noise level (1 dB), Red alarms (b = −0.3; 95% CI: −1.237 to 0.63; p = 0.52). The R Square of the model with all alarms was 0.01 (standard error of estimate, 6.9; p < 0.001).ConclusionsSound levels were high during all day-periods. Alarms exceeding limits occurred most frequently. However, the contribution of alarms to sound levels measured at the nursing station is clinically limited.     

Pilates method on pulmonary function and range of motion after coronary artery bypass grafting: A clinical trial

IntroductionCoronary artery bypass grafting (CABG) can compromise pulmonary function and range of motion (ROM) of the shoulder and knee joints due to median sternotomy and saphenectomy, the Pilates method being a strategy for reducing loss.ObjectiveTo evaluate the effect of applying the Pilates method on pulmonary function and ROM in patients undergoing CABG.Methodology: This is a clinical trial. Patients were evaluated preoperatively at discharge from the hospital for shoulder flexion and abduction and knee flexion-extension. In addition, vital capacity(VC), maximum inspiratory pressure(MIP), expiratory pressure(MEP) and peak expiratory flow(PEF) were evaluated. Upon discharge from the Intensive Care Unit (ICU), they were divided into a control group(CG) that received conventional assistance and Pilates(PG) was increased with Pilates method techniques.Results40 patients were analyzed, 25 were men(61%), with a mean age of 66 ± 7 years. At the end, the left shoulder abduction in the CG was 105±9vs115 ± 8 in the PG(p = 0.03), the right shoulder abduction in the CG 104 ± 11vs116 ± 10 in the PG(p < 0.001) and right knee flexion in the CG 78 ± 13vs92 ± 9 in the PG(0.002). In relation to MIP, the CG had a loss of 32 ± 8 while the PG 18 ± 10cmH2O(p < 0.001), the worsening MEP was 31 ± 9(CG)vs29 ± 11cmH2O(PG)(p = 0.53), the VC in the CG reduced 8±9vs6±8 in the PG(p = 0.23) and the PEF reduced 107 ± 5 in the GCvs83 ± 88 in the PG(p = 0.09).ConclusionIt is concluded that the Pilates method decreased the loss of ROM and maximum inspiratory pressure in patients undergoing coronary artery bypass grafting.     

Intensive care patients receiving vasoactive medications: A retrospective cohort study

BackgroundVasoactive medications are high-risk drugs commonly used in intensive care units (ICUs), which have wide variations in clinical management.ObjectivesThe aim of this study was to describe the patient population, treatment, and clinical characteristics of patients who did and did not receive vasoactive medications while in the ICU and to develop a predictive tool to identify patients needing vasoactive medications.MethodsA retrospective cohort study of patients admitted to a level three tertiary referral ICU over a 12-month period from October 2018 to September 2019 was undertaken. Data from electronic medical records were analysed to describe patient characteristics in an adult ICU. Chi square and Mann–Whitney U tests were used to analyse data relating to patients who did and did not receive vasoactive medications. Univariate analysis and Pearson's r² were used to determine inclusion in multivariable logistic regression.ResultsOf 1276 patients in the cohort, 40% (512/1276) received a vasoactive medication for haemodynamic support, with 84% (428/512) receiving noradrenaline. Older patients (odds ratio [OR] = 1.02; 95% confidence interval [CI] = 1.01–1.02; p < 0.001) with higher Acute Physiology and Chronic Health Evaluation (APACHE) III scores (OR = 1.04; 95% CI = 1.03–1.04; p < 0.001) were more likely to receive vasoactive medications than those not treated with vasoactive medications during an intensive care admission. A model developed using multivariable analysis predicted that patients admitted with sepsis (OR = 2.43; 95% CI = 1.43–4.12; p = 0.001) or shock (OR = 4.05; 95% CI = 2.68–6.10; p < 0.001) and managed on mechanical ventilation (OR = 3.76; 95% CI = 2.81–5.02; p < 0.001) were more likely to receive vasoactive medications.ConclusionsMechanically ventilated patients admitted to intensive care for sepsis and shock with higher APACHE III scores were more likely to receive vasoactive medications. Predictors identified in the multivariable model can be used to direct resources to patients most at risk of receiving vasoactive medications.     

Australian and Danish nurses’ and midwives’ wellbeing during COVID-19: A comparison study

BackgroundMost investigations of nurses’ and midwives’ psychological wellbeing during the COVID-19 pandemic have been conducted in a single setting.AimTo assess and compare the psychological wellbeing of nurses and midwives in Australia and Denmark during the COVID-19 pandemic.MethodsNurses and midwives employed at four metropolitan health services in Australia and one in Denmark completed an anonymous online survey, which assessed depression, anxiety, and stress symptoms (The Depression, Anxiety and Stress Scale - 21 Items (DASS-21)), and sociodemographic and employment factors.FindingsCompleted surveys were received from 3001 nurses and midwives (1611 Australian and 1390 Danish). Overall, approximately one in seven of the nurses and midwives surveyed reported moderate to extremely severe levels of depression (n = 399, 13.5%), anxiety (n = 381, 12.9%) and stress (n = 394, 13.4%). Australian nurses’ and midwives’ scores on all DASS-21 subscales were significantly higher (representing higher levels of depression, anxiety and stress) than the scores for the Danish nurses and midwives. Fewer years of clinical experience, living in Australia and being employed on a part-time basis were significantly associated with higher levels of psychological distress.DiscussionA considerable proportion of nurses and midwives experienced distress during the COVID-19 pandemic; however, the proportion and severity varied by country. Australian nurses and midwives experienced higher levels of distress than their Danish colleagues.ConclusionNurses and midwives working in countries with relatively low numbers of COVID-19 cases and deaths are also likely to experience psychological distress. Nurses and midwives would benefit from targeted country-specific support and wellbeing initiatives.     

Associations between health behaviors and mental health in Australian nursing students

Aim: Nursing students experience high levels of stress, anxiety and depression. This study examined associations between health behaviors and stress, anxiety and depression in Australian nursing students. Design: this was a cross-sectional study. Methods: Participants completed an online survey providing demographic information and responses to the 21-item Depression Anxiety Stress Scale, Fagerström Test for Nicotine Dependence, short Food Frequency Questionnaire, Alcohol Use Disorders Identification Test, International Physical Activity Questionnaire and Workforce Sitting Questionnaire. Associations were evaluated using multivariate linear regression. Results: Mild to extremely severe stress (46.6%), anxiety (52.8%) and depression (42.2%) were prevalent. Intake of snack-foods was associated with higher depression (β = 8.66, p < 0.05) and stress (β = 3.92, p = 0.055) scores. More time spent sitting was associated with higher depression (β = 0.48, p < 0.001) and stress (β = 0.28, p < 0.05) scores. Skipping meals correlated with higher stress, anxiety and depression scores. Conclusion: More support must be provided to nursing students to manage psychological distress and mental health during university study.     

Improvement of quality of life and postural balance of institutionalized elderly people undergoing to a treadmill walking training

IntroductionInstitutionalized older adults have fewer opportunities to participate in daily living activities and tasks in an independent manner, with greater deleterious effects on the physiological losses inherent to aging and with increased gait and balance impairment compared to community-dwelling older adults. The use of a treadmill for rehabilitation, with or without partial weight support, has been studied in different groups, but not on institutionalized older adults.ObjectivesTo assess the effects of a treadmill walking program on the postural balance and quality of life of institutionalized older adults.MethodsThirty-seven institutionalized older adults: intervention group (n = 23, 75.7 ± 7.8 years) and control group (n = 14, 78.9 ± 10.2 years). A total of 10 weeks of treadmill walking, twice a week (intervention group) vs. no training (control group). Postural balance was assessed by the Tinetti test, 6-min walk test (6MWT), and 10-m walk test and Quality of life with the WHOQOL-Bref questionnaire.ResultsSignificant improvement was observed in balance parameters (6MWT distance: p < 0.001; gait speed 6MWT: p < 0.001; gait speed 10MWT: p < 0.001; Tinetti scale: p = 0.001), and in the physical (p = 0.01), psychological (p = 0.002), self-assessed quality of life (p = 0.01) and overall quality of life domains (p = 0.002).ConclusionsTreadmill walking program had positive effects on the postural balance and quality of life of institutionalized older adults.     

Assessment of Post–Percutaneous Coronary Intervention Ambulatory Care by Advanced Practice Providers

Aim and MethodsThis study compared clinical and financial outcomes in post–percutaneous coronary intervention (PCI) ambulatory patients (n = 308) managed by advanced practice providers (APPs) versus cardiologists (Physician Providers [PPs]) over a period of 12 months.ResultsBoth groups (PPs, n = 164; APPs, n = 144) were similar in their baseline characteristics and experienced similar rates of major adverse cardiac events (12% vs. 13%; p = 0.792) as well as mortality (3% vs. 6.2%; P = 0.178). The APP group had significantly lower mean cost of cardiac care ($1,432 ± 282 vs. $1,642 ± 181; P < 0.001).ConclusionAPPs can provide high-quality care for post-PCI patients without increasing cost of care.