The effect of individualized education on the transfer anxiety of patients with myocardial infarction and their families

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

BACKGROUND

Transferring 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.

OBJECTIVE

The aim of the study is to evaluate the intra-hospital transfer anxiety of patients in a neurosurgery intensive care unit and factors affecting it.

METHODS

This 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.

RESULTS

The 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).

CONCLUSIONS

The 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 PRACTICE

The 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.

The effect of a family-based participatory care program on anxiety in patients with acute coronary syndrome in coronary care units: A randomised controlled clinical trial

BACKGROUND

Admission to the coronary care units (CCUs) and the patient's reduced interaction with family are regarded as important sources of anxiety. Family participation in care programs is pivotal to patient outcomes.

OBJECTIVES

The present study was conducted to determine the effect of a care program based on family participation on anxiety in patients with acute coronary syndrome.

METHODS

This randomised controlled trial was conducted on 90 patients in CCUs and their families. The patients were randomly assigned to one of the following three groups: routine care, control, and intervention. Routine care measures were provided to the routine care group, increased participation of the family was ensured in the control group, and a family-based participatory care program was implemented in the intervention group with the interaction of the nurse, patient, and family based on five principles, including presence, determination of needs, communication, participation in decision-making, and cooperation in care. The patients' anxiety was measured in the three groups on day 1 and 3 days after the admission to the CCU using the Spielberger State-Trait Anxiety Inventory.

RESULTS

The patients' mean state anxiety score before the intervention was 44.4 ± 12.7, 46.6 ± 12.4, and 45.5 ± 12.1 in the routine care, control, and intervention groups, respectively, with no significant differences between them (P = 0.81). After adjusting for anxiety before the intervention and study hospital, the mean (before-after) changes in anxiety score in the three groups showed that anxiety was significantly lower in the intervention group than in the other groups (P < 0.05).

CONCLUSION

Increased family presence alone has no effect on the patients' anxiety, but the family's participation and interaction with the care team can affect anxiety levels in cardiac patients in CCUs and improve the care processes.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials, Trial No. IRCT201105146481N1.

Transfer anxiety in parents of children transferred from pediatric intensive care units to general wards in South Korea: a hybrid concept analysis

Purpose

This study aimed to analyze the concept of transfer anxiety in parents of children transferred from pediatric intensive care units to general wards.

Methods

The hybrid model by Schwarz-Barcott and Kim was used to analyze the characteristics of transfer anxiety in parents of children transferred from pediatric intensive care units to general wards.

Results

Transfer anxiety was defined by the following attributes: 1) stress concerning the adaptation process, 2) concern about the child’s condition worsening due to the parent’s caregiving, and 3) involuntary changes in daily life due to the treatment. Transfer anxiety has the following antecedents: 1) uncertainty; 2) a lack of knowledge about the illness, medical devices, and caregiving; and 3) a lack of social support. It resulted in 1) caregiver burden, 2) a decrease in the capacity for coping with caregiving, 3) delays in the child’s physical and psychological recovery, and 4) decreased quality of life.

Conclusion

It is necessary to develop an assessment scale that considers the attributes of transfer anxiety in parents of children transferred from pediatric intensive care units to general wards. Furthermore, an effective nursing intervention should be developed to reduce transfer anxiety.

The effect of provision of information on serum cortisol in patients transferred from the coronary care unit to the general ward: A randomised controlled trial

BACKGROUND AND AIM

Patients' transfer from coronary care units to general wards is a main source of anxiety for patients. Transfer anxiety is due to either lack of patients' knowledge or inadequacy of transfer-related information to patients. This study aimed to evaluate the effect of provision of information on the serum cortisol level, as an indicator of anxiety, in patients transferred from the coronary care unit to the general ward.

METHODS

This pretest-posttest randomised clinical trial was conducted on fifty patients transferred from coronary care units to general wards. Patients were selected using a purposeful sampling method and randomly were allocated to control and intervention groups. After taking blood samples for a baseline cortisol measurement, the patients in the control group received routine verbal transfer-related information. The patients in the intervention group were provided with an educational pamphlet consisting of textual and visual data about patients' transfer, continuity of care and the target general ward. The second and the third blood samples were taken for a cortisol measurement half an hour after informing the patients about the transfer order and half an hour after entrance to the general ward, respectively. Descriptive and inferential statistics via the SPSS software v. 21 was used for data analysis.

RESULTS

No statistically significant differences were reported between the groups in terms of demographic characteristics (p > 0.05). The serum levels of cortisol in the intervention group decreased from 40.16 (microgram per decilitre) at the baseline to 36.52 and 34.34 at the second and the third measurement time points, respectively. Conversely, the serum levels of cortisol in the control group increased from 37.48 at the baseline to 40.52 and 41.52 at the second- and the third-time points, respectively. While no statistically significant difference was reported between the groups in the baseline serum level of cortisol, between-group differences were statistically significant at the second- and the third-time points (p < 0.05).

CONCLUSION

Provision of transfer-related information can reduce transfer anxiety among patients, that should be transferred from coronary care units to general wards.

The effect of education on the anxiety of a family with a patient in critical care unit: a systematic review and meta-analysis

BACKGROUND

Studies have shown that family members of patients in intensive care units experience high levels of anxiety. Contradictions in the results of the studies conducted regarding the effect of training on the anxiety level of such families, emphasize the necessity of employing other research methods to eliminate these ambiguities.

OBJECTIVE

This study applied meta-analysis to determine the effect of training on the anxiety level of families with patients in the intensive care unit.

METHODS

In order to find electronically published studies from 1990 to 2016, the articles published in journals indexed in the following databases were used: Elsevier, Scopus, ProQuest, ISI, Web of Science, PubMed, Google scholar and Cochrane. For data analysis Stata Software version 11 was used and the heterogeneity index of studies was determined through Cochran (Q) and I². Due to the heterogeneity, the random effect model was used to estimate the difference between the standardized mean of anxiety.

RESULTS

In this meta-analysis and systematic review article, eight articles were found to be eligible. The number of samples in the initial studies into a meta-analysis included 387 patients in the intervention group and 393 people in the control group. Standardized difference of the mean anxiety score in the intervention group was -0.329 (CI 95%: -0.756-0.099) units less than that of the control group, indicating that this effect was not statistically significant.

CONCLUSIONS

The results of this meta-analysis show that training will decline the anxiety level of a family with patients hospitalized in the intensive care unit, although the impact is not considerable.

A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward

AIMS AND OBJECTIVES

To develop and examine a relocation stress intervention programme tailored for the family caregivers of patients scheduled for transfer from a surgical intensive care unit to a general ward.

BACKGROUND

Family relocation stress syndrome has been reported to be similar to that exhibited by patients, and investigators have emphasised that nurses should make special efforts to relieve family relocation stress to maximise positive contributions to the well-being of patients by family caregivers.

DESIGN

A nonequivalent control group, nonsynchronised pretest-post-test design was adopted.

METHODS

The study subjects were 60 family caregivers of patients with neurosurgical or general surgical conditions in the surgical intensive care unit of a university hospital located in Incheon, South Korea. Relocation stress and family burden were evaluated at three times, that is before intervention, immediately after transfer and four to five days after transfer.

RESULTS

This relocation stress intervention programme was developed for the family caregivers based on disease characteristics and relocation-related needs. In the experimental group, relocation stress levels significantly and continuously decreased after intervention, whereas in the control group, a slight nonsignificant trend was observed. Family burden levels in the control group increased significantly after transfer, whereas burden levels in the experimental group increased only marginally and nonsignificantly. No significant between-group differences in relocation stress or family burden levels were observed after intervention.

CONCLUSIONS

Relocation stress levels of family caregivers were significantly decreased after intervention in the experimental group, which indicates that the devised family relocation stress intervention programme effectively alleviated family relocation stress.

RELEVANCE TO CLINICAL PRACTICE

The devised intervention programme, which was tailored to disease characteristics and relocation-related needs, may enhance the practicality and efficacy of relocation stress management and make meaningful contribution to the relief of family relocation stress, promote patient recovery and enhance the well-being of patients and family caregivers.

Orientação de enfermagem sobre o banho no leito para redução da ansiedade

RESUMOObjetivo:avaliar a efetividade de um protocolo de orientação de enfermagem para redução da ansiedade de pacientes com síndrome coronária aguda, submetidos ao banho no leito e a relação dos sinais vitais com a Ansiedade-Estado.Método:ensaio clínico randomizado. A amostra foi constituída por 120 pacientes. O grupo intervenção recebeu um protocolo de orientação de enfermagem sobre o banho no leito e o grupo controle as informações rotineiras da unidade. A ansiedade foi avaliada por meio do Inventário de Ansiedade-Estado em três momentos: imediatamente após informar ao paciente sobre a necessidade do banho no leito, imediatamente após as intervenções e imediatamente após o banho.Resultados:o grupo intervenção teve uma redução significativamente maior da ansiedade quando comparado ao grupo controle (p<0,001) após a intervenção.Conclusão:a orientação de enfermagem foi efetiva para reduzir a ansiedade dos pacientes com síndrome coronária aguda que se submetem ao banho no leito.

The effects of inhalation aromatherapy on anxiety in patients with myocardial infarction: a randomized clinical trial

Background:

Anxiety is an important mental health problem in patients with cardiac disease. Anxiety reduces patients’ quality of life and increases the risk of different cardiac complications.

Objectives:

The aim of this study was to investigate the effects of inhalation aromatherapy on anxiety in patients with myocardial infarction.

Patients and Methods:

This was a randomized clinical trial conduced on 68 patients with myocardial infarction hospitalized in coronary care units of a large-scale teaching hospital affiliated to Kashan University of Medical Sciences, Kashan, Iran in 2013. By using the block randomization technique, patients were randomly assigned to experimental (33 patients receiving inhalation aromatherapy with lavender aroma twice a day for two subsequent days) and control (35 patients receiving routine care of study setting including no aromatherapy) groups. At the beginning of study and twenty minutes after each aromatherapy session, anxiety state of patients was assessed using the Spielberger’s State Anxiety Inventory. Data was analyzed using SPSS v. 16.0. We used Chi-square, Fisher’s exact, independent-samples T-test and repeated measures analysis of variance to analyze the study data.

Results:

The study groups did not differ significantly regarding baseline anxiety mean and demographic characteristics. However, after the administration of aromatherapy, anxiety mean in the experimental group was significantly lower than the control group.

Conclusions:

Inhalation aromatherapy with lavender aroma can reduce anxiety in patients with myocardial infarction. Consequently, healthcare providers, particularly nurses, can use this strategy to improve postmyocardial infarction anxiety management.

Transfer out of intensive care: an evidence-based literature review

Critical care beds are a finite resource. Transfer or discharge of patients from the intensive care unit affects the flow of patients in critical care. Effective whole hospital bed management is key to the successful management of the critical care service. However, admission to the critical care unit alone can be extremely frightening, distressing, and traumatic not only for the patients but their families as well. Although transfer to the medical floors is a positive step toward physical recovery, it can be equally traumatic, and many patients and their families exhibit stress, fear, and anxiety. The purpose of this article was to systematically review the effects of intensive care unit transfer or discharge to medical-surgical floors on adult critically ill patients, their family members and nurses.

Efficacy of information interventions in reducing transfer anxiety from a critical care setting to a general ward: a systematic review and meta-analysis

PURPOSE

Our aim was to undertake a comprehensive systematic review on the efficacy of information interventions on reducing anxiety in patients and family members on transfer from a critical care setting to a general ward.

MATERIALS AND METHODS

MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Google Scholar databases from 1990 to January 1, 2011, were searched. Bibliographies of identified articles were reviewed. Only high-quality randomized controlled trials comparing an intervention to reduce transfer anxiety with standard care, where transfer anxiety is measured by the validated State Trait Anxiety Inventory, were included. Data were extracted to estimate standard mean differences (SMDs), pooled odds ratios (ORs), and 95% confidence intervals (CIs) using both fixed and random effects model.

RESULTS

Of 266 studies identified in the primary search, 5 studies enrolling 629 participants met the inclusion criteria, family members' transfer anxiety was significantly reduced in the intervention arm of information provision (OR, 1.70; 95% CI, 1.15-2.52; P = .01) compared with those who received standard care (OR, 0.42; 95% CI; 0.276-0.625; P < .001), and patients' transfer anxiety was significantly reduced in one study.

CONCLUSIONS

Providing information to understand a future ward environment can significantly reduce patients' and family members' transfer anxiety from the critical care setting when compared with standard care.

The incomplete infrastructure for interhospital patient transfer

OBJECTIVE

Interhospital transfer of critically ill patients is a common part of their care. This article sought to review the data on the current patterns of use of interhospital transfer and identify systematic barriers to optimal integration of transfer as a mechanism for improving patient outcomes and value of care.

DATA SOURCE

Narrative review of medical and organizational literature.

SUMMARY

Interhospital transfer of patients is common, but not optimized to improve patient outcomes. Although there is a wide variability in quality among hospitals of nominally the same capability, patients are not consistently transferred to the highest quality nearby hospital. Instead, transfer destinations are selected by organizational routines or non-patient-centered organizational priorities. Accomplishing a transfer is often quite difficult for sending hospitals. But once a transfer destination is successfully found, the mechanics of interhospital transfer now appear quite safe.

CONCLUSION

Important technological advances now make it possible to identify nearby hospitals best able to help critically ill patients, and to successfully transfer patients to those hospitals. However, organizational structures have not yet developed to insure that patients are optimally routed, resulting in potentially significant excess mortality.

Guided transfer of critically ill patients: where patients are transferred can be an informed choice

PURPOSE OF REVIEW

Given increasingly scarce healthcare resources and highly differentiated hospitals, with growing demand for critical care, interhospital transfer is an essential part of the care of many patients. The purpose of this review is to examine the extent to which hospital quality is considered when transferring critically ill patients, and to examine the potential benefits to patients of a strategy that incorporates objective quality data into referral patterns.

RECENT FINDINGS

Interhospital transfer of critically ill patients is now common and safe. Although extensive research has focused on which patients should be transferred and when they should be transferred, recent study has focused on where patients should be transferred. Yet, the choice of destination hospital is rarely recognized as a therapeutic choice with implications for patient outcomes. The recent public release of high-quality, risk-adjusted and reliability-adjusted outcome data for most hospitals now offers physicians an informed basis on which to choose to which destination hospital a patient should be transferred. A strategy of 'guided transfer' that integrates public quality information into critical care transfer decisions is now feasible.

SUMMARY

Although hospitals often transfer patients, there may be substantial room for improvement in transfer patterns. Guiding transfers on the basis of objective quality information may offer substantial benefits to patients, and could be incorporated into quality improvement initiatives.

A systematic review of relocation stress following in-house transfer out of critical/intensive care units

EXECUTIVE SUMMARY

Objective The objective was to conduct a mixed methods systematic review to determine the occurrence and meaningfulness of relocation stress and the effectiveness of strategies for decreasing transfer anxiety in patients and their families upon transfer from an intensive care unit to a non-intensive care unit and to offer evidence-based recommendations for best practice.Inclusion criteria The review included quantitative and qualitative studies where the participants were adult intensive care patients, family members of adult intensive care patients, intensive care nurses caring for the adult critically ill patient, and ward/unit nurses receiving transfer patients from the ICU (intensive care unit). Studies examining the transfer experience for infants, children or psychiatric patients were excluded from this review.Search strategy The search strategy sought to find both published and unpublished studies and papers limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms to describe the article. A second extensive search was then undertaken using identified key words and index terms.Methodological quality Each paper was assessed by two independent reviewers for quality prior to inclusion in the review using the Joanna Briggs Critical Appraisal Tools for experimental, cohort, descriptive, qualitative and expert text papers. Disagreements were discussed and resolved among the reviewers without needing to rely on a third reviewer.Data collection Information was extracted from each paper independently by two reviewers using the JBI extraction tools for quantitiative, qualitaitive and expert opinion papers and narrative table summaries were prepared.Data synthesis Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the experiences of patients and families transferring out of ICU and the nurses on the receiving and sending ends of the transfer.Results A total of 35 studies were identified and of those 25 were included in the review consisting of 15 qualitative studies, 9 quantitative studies and 1 clinical practice guideline. Qualitative papers were analyzed using JBI-QARI and involved categorizing findings and developing synthesized topics from the categories. Three syntheses were developed related to response to transfer, meaning of transfer, and strategies to facilitate successful transfer. Quantitative data could not be pooled and is presented in the narrative table.Conclusion For most, transfer to the general unit was not a traumatic or negative experience but viewed positively as a sign of recovery and sometimes the positive emotions coexisted with uncertainty or fear. The most negative experience was related to lack of observation and care on the general unit where nurses many times were unaware or unresponsive to functional deficits that the patients required assistance with. Patients were consequently challenged to do more for themselves and depending on their success or progress with independence resulted in growing confidence or frustration and embarrassment. The systems of care were not structured to effectively deal with the complex ICU transfer patient.Implications for practice Specific practice recommendations are made for pretransfer from ICU, system improvements to facilitate transfer and posttransfer care while on the general unit.Implications for research Additional research is needed to confirm the frequency of negative relocation stress, test efficacy of direct interventions and explore the meaning of transfer for family members.

Interhospital transfers among Medicare beneficiaries admitted for acute myocardial infarction at nonrevascularization hospitals

BACKGROUND

Patients with acute myocardial infarction (AMI) who are admitted to hospitals without coronary revascularization are frequently transferred to hospitals with this capability, yet we know little about the basis for how such revascularization hospitals are selected.

METHODS AND RESULTS

We examined interhospital transfer patterns in 71 336 AMI patients admitted to hospitals without revascularization capabilities in the 2006 Medicare claims using network analysis and regression models. A total of 31 607 (44.3%) AMI patients were transferred from 1684 nonrevascularization hospitals to 1104 revascularization hospitals. Median time to transfer was 2 days. Median transfer distance was 26.7 miles, with 96.1% within 100 miles. In 45.8% of cases, patients bypassed a closer hospital to go to a farther hospital that had a better 30-day risk standardized mortality rates. However, in 36.8% of cases, another revascularization hospital with lower 30-day risk-standardized mortality was actually closer to the original admitting nonrevascularization hospital than the observed transfer destination. Adjusted regression models demonstrated that shorter transfer distances were more common than transfers to the hospitals with lowest 30-day mortality rates. Simulations suggest that an optimized system that prioritized the transfer of AMI patients to a nearby hospital with the lowest 30-day mortality rate might produce clinically meaningful reductions in mortality.

CONCLUSIONS

More than 40% of AMI patients admitted to nonrevascularization hospitals are transferred to revascularization hospitals. Many patients are not directed to nearby hospitals with the lowest 30-day risk-standardized mortality, and this may represent an opportunity for improvement.