Coping strategies of family members of intensive care unit patients

ObjectiveTo analyse the coping strategies of family members of patients admitted to intensive care units.DesignA cross-sectional study developed with 70 relatives of patients admitted to the intensive care unit.SettingAn adult intensive care unit at a university hospital in Brazil.Main Outcome MeasuresCoping strategies were identified by the Folkman and Lazarus Inventory of Coping Strategies and statistically compared to the sociodemographic data of family members and patients’ clinical data.ResultsCoping strategies focused on emotion were the most used, especially those attributed to the escape-avoidance factor. There was a significant association (p < 0.05) between women and the use of adaptive strategies focused on the problem; less education and lower income with maladaptive strategies focused on emotion; second-degree relatives and the positive reassessment factor; participants involved in religious activities and the social support factor. Regarding the clinical variables, patients admitted to the intensive care unit for more than seven days showed an association (p < 0.05) with the social support factor.ConclusionFamily members used adaptive coping strategies more focused on emotion. Additionally, the lower the educational and economic levels, the greater the use of maladaptive strategies focused on emotion.     

Predicting psychological distress of informal carers of individuals with major depression or bipolar disorder

Caring for someone with a mental illness is associated with high levels of burden and psychological distress. Understanding these factors could be important to prevent the development of physical and mental health problems in carers. The purpose of the present study was to determine the contribution of coping styles and social support in predicting the psychological distress reported by informal carers (IC) of individuals with major depression or bipolar disorder. IC (n = 72) of adults with a diagnosed depressive illness were recruited from mental health organizations within the community setting. Carers completed the General Health Questionnaire, Brief COPE, and Social Support Questionnaire. Multiple linear regression analysis revealed that 63% of the variance in psychological distress could be accounted for by adaptive and maladaptive coping styles and perceived quantity and satisfaction with social support. Satisfaction with social support (β = ?0.508, P < 0.001) and maladaptive coping (β = 0.369; P < 0.001) were significant predictors of psychological distress. These findings suggest that interventions should consider coping styles, specifically the interaction between maladaptive behaviours and enhancement of quality of support, to assist carers to manage psychological distress, especially earlier in the caring role.     

Stigma experience of families supporting an adult member with substance misuse

Stigmatization of families supporting an adult member with substance misuse is common and undermines their capacity to support the person and maintain their own well‐being. The aims of the present study were to understand affected family members (AFMs)’ experience of stigma within the context of substance misuse, and to explicate what steps, if any, they took to try to counteract stigma and social isolation. Semistructured, audio‐recorded qualitative interviews were conducted with 31 AFMs from Victoria in Australia. Interpretative phenomenological analysis was used to guide data collection and analysis. Two main themes and related subthemes abstracted from the data illustrated how participants perceived and responded to stigma associated with a family member's substance misuse: ‘engaging in secrecy, and minimizing contact with others’ and ‘lack of knowledge and empathy, and judgmental attitudes reinforcing isolation’. A third theme, ‘adopting measures to moderate the effect of stigma’, highlights how some attempted to respond to stigma by challenging informal supports’ misconceptions about substance misuse, and being open selectively with others about their situation. Stigma against AFMs should be identified and challenged. Mental health nurses and other clinicians in the alcohol and other drugs field are in a strong position to support AFMs, with a particular focus on reducing courtesy stigma, challenging some clinicians’ judgmental attitudes, and improving ways of communicating with families.     

Randomized,controlled trial of a brief family‐centred care programme for hospitalized patients with bipolar disorder and their family caregivers

Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients’ symptoms and health; however, the effects of family interventions on family function and caregivers’ health‐related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family‐centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60‐min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90‐min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem‐solving (P = 0.04), but there were no significant interaction effects on the caregivers’ perceived health status and caregivers’ burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.     

Association of daily hassles,daily uplifts,coping styles and stress-related symptoms among women exposed to sexual abuse—A cross-sectional study

Background

Women who experience physical or sexual violence report poor self-perceived health. Knowledge of daily hassles, daily uplifts and coping styles, as well as how these factors can affect health and well-being among survivors of sexual abuse, is important for healthcare professionals to understand and target their needs.

Aim

The aim of the current study was to explore the association of daily hassles, daily uplifts, coping strategies and stress-related symptoms among female survivors of sexual abuse.

Methods

A group of women (n = 57), exposed to sexual abuse, were recruited from nine support centres in Norway. Participants completed a questionnaire that addressed demographics, socioeconomic conditions, trauma history, daily hassles, daily uplifts, coping styles and stress-related symptoms. Two groups of participants were compared: one group that had above-median scores on uplifts and adaptive coping styles and one group that had above-median scores on daily hassles and maladaptive coping styles.

Results

Results indicate that women who experienced more daily hassles and used maladaptive coping styles reported significantly more stress-related symptoms, and particularly emotional symptoms, than women who experienced more daily uplifts and used adaptive coping styles. There were few differences between the two groups related to socioeconomic conditions and trauma history.

Conclusion

The results indicate that women in both groups struggle with stress-related physical, emotional, cognitive and target group-specific symptoms. However, high incidence of daily hassles and the use of maladaptive coping styles were associated with an increase in stress-related symptoms. Novell’s findings indicate that despite severe traumatic experiences, adaptive coping styles and favourable perceptions of stress in everyday life were associated with a lower frequency of stress-related symptoms. It may therefore be helpful to focus on altering maladaptive coping styles to reduce stress-related symptoms among sexual abuse survivors.     

Comfort and religious-spiritual coping of intensive care patients’ relatives

ObjectivesTo identify the level of comfort and religious-spiritual coping of family members of intensive care unit patients and to analyse the sociodemographic/clinical variables that influence this association.MethodsCross-sectional study on the adult and paediatric intensive care units of two public hospitals in the state of São Paulo, between January and September 2016. Participants were divided into two groups: adult (n = 96) and paediatric (n = 70). We used the religious-spiritual coping brief (RSC-Brief) and the comfort scale for relatives of people in critical states of health (ECONF).ResultsComfort was low in both groups and the family members used limited strategies in the RSC-Brief. The multiple linear regression analysis indicated that the variable length of hospitalization (β = 0.69; p < 0.01) influenced comfort and was also associated with the RSC-Brief (β = -0.18; p < 0.01).ConclusionFamily members’ comfort was low in both groups. It increased with the hospitalisation time of the patients' relative and tended to decrease with the severity of the disease.     

Stress and coping of Hong Kong Chinese family members during a critical illness

Aim. The present study aimed to investigate the stress and coping strategies of Hong Kong Chinese families during a critical illness and to examine the relationships between stress and coping. Background. Admissions to intensive care unit are usually an unanticipated event, which imposes stress on the family. Family's wellness is one of the significant factors affecting patient's well‐beings. Much work has been conducted in Western societies. Stress and coping in Chinese families of critically ill patients have rarely been discussed. Method. Structured face‐to‐face interviews were conducted, using the Impact of Events Scale and the Family Crisis Oriented Personal Evaluation Scales. A convenience sample of 133 participants was recruited from a regional hospital in Hong Kong. Many were patients’ children with age between 30 and 49. A total of 39·1% (n = 52) of the participants were males and 60·9% (n = 81) were females. Results. The participants experienced high level of stress (mean = 25·1, SD = 8·3). Higher level of stress were experienced by female (t = ?4·6; d.f. = 1, 131; P = 0·00), those with lower educational attainment (F = 3·0; d.f. = 2, 130; P = 0·05) and those whose relatives were admitted to the intensive care unit unexpectedly (t = ?2·2; d.f. = 1; P = 0·03). Patients’ length of stay in the unit was significantly correlated with levels of stress (r = 0·5, P < 0·00). Level of stress had significant correlation with coping strategies utilization (r = 0·5, P < 0·00). Reframing strategies were frequently used whereas the passive appraisal strategies were least used. Family members used positive‐coping strategies, which concurred with the Chinese stress–coping pattern ‘fatalistic voluntarism’. Relevance to clinical practice. This study contributes to the understanding of Hong Kong Chinese families’ stress and coping during a critical illness. Comprehensive assessments of family members’ psychosocial needs are important to plan appropriate interventions to alleviate their stress and strengthen their coping skills. The findings will serve as guidance for nurses in delivering culturally sensitive and competent interventions.     

Effects of biogenetic beliefs for schizophrenia on potential caregivers in China: Exploring the role of affiliate stigma

Schizophrenia affects more than eight million people in China. Stigmatization of schizophrenia may prevent family members and close others from providing social support to those with schizophrenia. This article aims to investigate the potential use of a biogenetic approach to reduce the stigma of schizophrenia using a cross‐sectional (study 1, n = 141) and an experimental design (study 2, n = 100) in China. In the first study, mediation analysis reveals that perceived affiliate stigma, the negative prejudice, and discrimination towards family members of individuals with socially stigmatized identities due to their affiliation with the person mediates the path between biogenetic beliefs and desire for social distance. This pattern is replicated in study 2 in which two 10‐min lectures were created and used to influence participants’ beliefs in biogenetic causes of schizophrenia. Findings suggest that the biogenetic approach may increase Chinese participants’ desired social distance towards their family members with schizophrenia through increasing their concerns about the negative consequences of being affiliated with the family member. Therefore, future research should investigate aspects of biogenetic anti‐stigma campaigns that do not increase participants’ perception of affiliate stigma in China.     

Does clinical placement in a community alcohol and other drugs rehabilitation centre influence students’ career intention?

Due to an ageing workforce, there is a growing need for greater numbers of nurses to work in areas, such as mental health and alcohol and other drugs (AOD) rehabilitation. These practitioners need to approach their work as ‘recovery‐oriented practitioners’. Positive experiences and preceptorship during clinical placement in AOD rehabilitation settings might influence students’ later career choices and address some of the workforce shortage issues. The aim of the present concurrent, mixed‐methods study was to explore students’ perceptions of their clinical placement experience in a community‐based AOD rehabilitation setting, and to examine attitude, career intention, and satisfaction with the placement. Fifty‐eight students completed pre–post‐test surveys, with closed and open‐ended questions, which included standardized measures. A small sample of survey respondents also agreed to participate in a semistructured interview. The quantitative results revealed two predictors for higher intention to pursue a career in AOD: (i) a high satisfaction with their clinical placement (β = 0.29, P = 0.008); and (ii) a high baseline attitude to recovery‐oriented practice (β = 0.28, P = 0.013). The qualitative findings identified five factors influencing placement experience: (i) educational factors; (ii) students’ background factors; (iii) placement factors; (iv) client factors; and (v) staff factors. A model that synthesizes the quantitative and qualitative findings was also developed. In conclusion, clinical placement in a community‐based AOD rehabilitation centre improved students’ intention to work in that setting.     

Associative stigma and other harms in a sample of families of heavy drinkers in Lithuania

Introduction: The main aim of this study is to identify and contextualize the harms Lithuanian families experience when they include a heavy drinker. Methods: Twenty-four qualitative interviews with cohabiting spouses, and ex-partners of heavy drinkers were conducted in 2013–2014 and analysed for emergent themes. Results: Interviewees experienced an array of harms. These were categorised as: direct harms caused by the drinker; drinker-centred coping strategies which did not take children’s (and other adults’) needs into account and affected family members indirectly; abdication of or redirection of the drinker’s responsibilities to other family members; associative (reflected) stigma and isolation. Discussion: The direct harm caused by the drinker is only one fragment of alcohol’s harm to others. The drinker’s family members are stigmatised and commonly take on the usual roles and responsibilities of the drinker, with this particularly the case for women and their children. Internalisation of responsibility and drinker-centred coping styles also result in neglect of other family members’ needs. Conclusions: There are multiplicative effects from one family member’s heavy drinking on others, affecting adult members and children as they develop.     

Effectiveness of home visits by mental health nurses for Japanese women with post‐partum depression

Post‐partum depression affects 10–13% of Japanese women, but many do not receive appropriate treatment or support. This intervention study evaluated the effectiveness of home visits by mental health nurses for Japanese women with post‐partum depression. Eighteen post‐partum women met the inclusion criteria and were randomly allocated into the intervention (n = 9) or control (n = 9) group at 1–2 months after giving birth. The intervention group received four weekly home visits by a mental health nurse. Control group participants received usual care. Two women in the intervention group did not complete the study. Depressive symptoms and quality of life were measured at 1 and 6 weeks' postintervention. In addition, participants completed an open‐ended questionnaire on satisfaction and meaning derived from the home visits. Women in the intervention group had significant amelioration of depressive symptoms over time and reported positive benefits from the home visits, but there were no statistically significant differences between groups. Significant differences (P < 0.05) were observed at times 2 and 3 between groups in terms of increased median scores of physical, environmental, and global subscales, and the total average score of the World Health Organization/quality of life assessment instrument. On the psychological subscale, significant differences (P = 0.042) were observed between groups at time 2. The qualitative analysis of comments about home visitation revealed four categories related to ‘setting their mind at ease’, ‘clarifying thoughts’, ‘improving coping abilities’, and ‘removing feelings of withdrawal from others’. These results suggest that home visits by mental health nurses can contribute to positive mental health and social changes for women with post‐partum depression. A larger trial is warranted to test this approach to care.     

Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study

ObjectivesTo investigate family and health professional experience with a nurse-led family support intervention in intensive care.DesignQualitative evaluation study.SettingA twelve-bed surgical intensive care unit in a 900-bed University Hospital in Switzerland.Main outcome measuresData were collected through 16 semi-structured interviews with families (n = 19 family members) and three focus group interviews with critical care staff (n = 19) and analysed using content analysis strategies.FindingsFour themes related to the new family support intervention were identified. First, families and staff described it as a valuable and essential part of ICU care. Second, it facilitated staff-family interaction and communication. Third, from staff perspective, it promoted the quality of family care. Fourth, staff believed that the family support intervention enabled them to better care for families through increased capacity for developing and sustaining relationships with families.ConclusionsAn advanced practice family nursing role coupled with a family support pathway is an acceptable, appreciated and beneficial model of care delivery in the inttensive care unit from the perspective of families and critical care staff. Further research is needed to investigate the intervention’s effectiveness in the intensive care unit.     

Multidimensional approach to restraint minimization: The journey of a specialized mental health organization

The executive‐level witnessing and review of restraint events has been identified as a key strategy for restraint minimization. In the present study, we examined the changes in restraint practices at a tertiary‐level mental health‐care facility with implementation of an initiative, in which representatives from senior management, professional practice, peer support, and clinical ethics witnessed seclusion and restraint events, and rounded with clinical teams to discuss timely release and brainstorm prevention strategies. Interrupted time series analysis compared the change from pre‐implementation (14 months prior) to postimplementation (35 months’ following) in the number of incidents/month, total hours/month, and average hours/incident/month for each of seclusion and mechanical restraint. With implementation, there was a step decrease in average hours/seclusion (–28.3 hours/seclusion, P < 0.001) and total seclusion hours (–1264.5 hours, P = 0.002). The postimplementation rate of decrease of –0.9 hours/incident/month was different than the pre‐implementation rate of increase of 0.7 hours/incident/month for mechanical restraint (P = 0.03). Pre‐implementation, there was a rate of decrease of 6.1 incidents/month (P < 0.001) and 4.5 incidents/month (P = 0.001) for seclusion and mechanical restraint, respectively. Postimplementation, there was a rate of increase of 0.3 incidents/month and a rate of decrease of 0.05 incidents/month for seclusion and mechanical restraint, respectively, both of which were different than pre‐implementation (seclusion: P < 0.001, mechanical restraint: P = 0.002). In conclusion, the total hours of seclusion and average hours per seclusion and per restraint incident were reduced, demonstrating the value of leadership witnessing and daily rounds in promoting restraint minimization in tertiary‐level mental health care.     

Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity

To analyze the effect of loss of exclusivity of data on the cost of treatment of peripheral neuropathic pain (PNP) with pregabalin or gabapentin in routine clinical practice. A retrospective observational study, with electronic medical records for patients enrolled at primary care centers managed by the health care provider Badalona Serveis Assistencials, who initiated treatment of PNP with pregabalin or gabapentin. The analysis used drugs and resources prices for year 2015. The 1163 electronic medical records (pregabalin; N = 764, gabapentin; N = 399) for patients (62.2% women) with a mean (standard deviation) age of 59.2 (14.7) years were analyzed. Treatment duration was slightly shorter with pregabalin than with gabapentin (5.2 vs 5.5 months; P = 0.124), with mean doses of 227.4 (178.6) mg and 900.0 (443.4) mg, respectively. The average study drug cost per patient was higher for pregabalin than for gabapentin; €214.6 (206.3) vs €157.4 (181.9), P < 0.001, although the cost of concomitant analgesic medication was lower; €176.5 (271.8) vs €306.7 (529.2), P < 0.001. The adjusted average total cost per patient was lower in those treated with pregabalin than in those treated with gabapentin; €2,413 (2119‐2708) vs €3201 (2806–3.597); P = 0.002, owing to significantly lower health care costs; €1307 (1247‐1367) vs €1538 (1458‐1618), P < 0.001, and also non‐health care costs; €1106 (819‐1393) vs €1663 (1279‐2048), P = 0.023, that was caused by a significantly lower use of concomitant medication, fewer medical visits to primary care, and fewer days of sick leave. After loss of exclusivity of both drugs, pregabalin continued to show lower health care and non‐health care costs than gabapentin in the treatment of PNP in routine clinical practice.     

Effectiveness of a community‐based nurse‐led lifestyle‐modification intervention for people with serious mental illness and metabolic syndrome

The development of metabolic syndrome negatively affects the quality of life of people with serious mental illness. Experts agree on the need to evaluate the physical health of patients and intervene in modifiable risk factors, with emphasis on the promotion of healthy lifestyles. Interventions should include nutritional counselling and physical activity. This 24‐week randomized trial evaluated the effects of a community‐based nurse‐led lifestyle‐modification intervention in people with serious mental illness meeting metabolic syndrome criteria, and its impact on health‐related quality of life and physical activity. Sixty‐one participants from two community mental health centres were randomly assigned to the intervention or control group. The intervention consisted of weekly group sessions, with 20 min of theoretical content and 60 min of nurse‐led physical activity. Postintervention results between groups showed no differences in weight, waist circumference, fasting glucose, and systolic blood pressure. Differences in body mass index, triglyceride concentrations, and diastolic blood pressure were found to be significant (P = 0.010, P = 0.038, and P = 0.017). Participants who performed the intervention reported an increase in physical activity, which did not occur in the control group (P = 0.035), and also reported better health status (P < 0.001). Our intervention showed positive effects reducing participants’ cardiovascular and metabolic risks and improving their physical activity and quality of life. To our knowledge, this is the first clinical trial led and carried out by mental health nurses in community mental health centres which takes into account the effects of a lifestyle intervention on every metabolic syndrome criterion, health‐related quality of life, and physical activity.     

Predictors of depressive symptoms and physical health in caregivers of individuals with schizophrenia

This cross‐sectional study examined relationships among factors influencing caregiver burden, depressive symptoms, and physical health in family caregivers of individuals with schizophrenia. Two hundred family caregivers of individuals with schizophrenia completed standardized questionnaires related to depressive symptoms, physical health, perceptions of burden, coping, and social support. The results revealed that 19.5% of family caregivers of individuals with schizophrenia experienced significant depressive symptoms and 65.5% perceived themselves in poor physical health. Burden, self‐controlling coping strategies, and physical health status were all independently predictive of depressive symptoms. Two emotion‐focused coping strategies (self‐controlling and escape‐avoidance) were independently predictive of caregiver burden. Only burden predicted physical health status. The findings suggest that health professionals who provide community care for those with schizophrenia need to consider the “unit of care” as the family rather than the individual. The health status of family caregivers should be routinely assessed. Individualized interventions to reduce family burden could include community‐based health professionals as well as trained community volunteers, opportunities for social interaction, and improving self‐care for all family members.     

The psychological health of emergency physicians in Australasia

Objective: To evaluate the psychological health of ACEM Fellows and the important factors that impact on this health. Methods: A cross‐sectional, mail survey utilizing validated psychological instruments. Results: Three hundred and twenty‐three (63.5%) of 510 physicians responded. Most were recently graduated males. Compared to a general population sample, their psychological health was good with greater optimism and mastery (P < 0.001), less anxiety, depression and physical symptoms (P < 0.001), better life satisfaction (P = 0.04) and similar perceived stress (P = 0.20). The mean work stress score (1 = low, 10 = high) was 5.6 ± 2.1 (moderate stress) although 63 (19.5%) had very high scores (8–10). The mean work satisfaction score was 6.3 ± 2.1 (moderate satisfaction) although 43 (13.3%) had very low scores (1–3). Perceptions of control over hours worked and mix of professional activities were positively associated with work and life satisfaction (P < 0.001) and negatively associated with work stress and measures of wellbeing (P < 0.001). Most employed adaptive coping strategies. However, maladaptive strategies (alcohol/drugs, denial, disengagement) were positively associated with anxiety, depression and stress (P < 0.001). Conclusions: Most physicians are psychologically healthy. However, there appears to be a subgroup that is not thriving. Workplace stress should be addressed promptly and greater flexibility provided over hours worked and mix of professional activities.