Thoracic and cardiovascular surgery patients: Intensive care unit experiences

Association between needs and anxiety/depression in family of intensive care patients

BACKGROUND

When a loved one is hospitalised in the intensive care unit (ICU), the family members' attention is on the patient's condition. This can interfere with family members' own needs and affect psychological wellbeing.

AIMS

To investigate the needs and stressors of family members of patients in ICU and their associations with symptoms of anxiety and depression during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted with 340 family members of patients admitted to the ICU of a public hospital in São Paulo state, Brazil, between January 2020 and August 2022. Data on sociodemographic characteristics were collected. The Critical Care Family Needs Inventory (CCFNI) and the Hospital Anxiety and Depression Scale (HADS) were administered.

RESULTS

Family members of patients in the ICU placed a very high level of importance on their needs (median=172). Although the family members were satisfied, not all their needs were met (median=116). In the multivariate analysis, the variables that influenced the CCFNI Importance/Satisfaction score were age (P<0.001), marital status (P<0.001), education level (P<0.001), Catholic religion (P<0.001), previous hospitalisation experience (P<0.001), and HADS depression (P=0.026/P=0.002). The variables that influenced the HADS score included female sex (P<0.001), age (P<0.001), direct relation to the patient (P<0.001), Catholic religion (P<0.001), living with the patient (P<0.001), and CCFNI Importance/Satisfaction (P<0.001).

CONCLUSIONS

Family members of patients in the ICU have essential, but not completely satisfied, needs. HADS was positively associated with the importance of needs and inversely related to the satisfaction of needs. Age and the Catholic religion were the only common variables affecting the variations in needs constructs.

Enhancing patient experience in the surgical ICU through virtual reality: A pre-post mixed-methods study

BACKGROUND

Patients in the Surgical Intensive Care Unit (SICU) often experience psychological stress.

OBJECTIVES

To evaluate the feasibility, acceptability, and potential outcomes of virtual reality (VR) interventions for enhancing patient experience during SICU stay.

METHODS

This mixed-method study employed a pre-post-test design complemented by a sequential explanatory approach, conducted from January to December 2023 in the SICU of a hospital in China. Quantitative data (n = 32) were collected using a Visual Analog Scale to assess pain, fatigue, depression, anxiety, and comfort. Physiological parameters, including blood pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) were obtained from a bedside patient monitor. Additionally, self-designed questionnaires were used to evaluate VR acceptance, while the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ) was used to assess discomfort related to VR interventions. Qualitative data from experimental patients (n = 10) were analyzed through in-depth interviews.

RESULTS

Post-intervention, patients showed significant reductions in pain, fatigue, depression, and anxiety, along with increased comfort levels (P < 0.05). There were no significant differences in pre- and post-intervention BP, HR, RR, or SpO2. The mean VR acceptance score was 3.90±0.62, with minimal discomfort reported. Qualitative analysis revealed four themes: positive patient attitude toward VR, benefits of VR for well-being, multiple influences on VR implementation, and implementation of VR with safety assurance.

CONCLUSION

VR interventions significantly reduced psychological stress and improved comfort in SICU patients, with high acceptance and minimal side effects. Further research is needed to optimize VR use in this setting.

A qualitative study exploring the experiences and needs of fear of disease progression in patients after open-heart surgery

OBJECTIVE

Open-heart surgery (OHS) is a stressful event for patients, all of whom experience varying levels of worry and fear, leading to fear of disease progression (FoP). An in-depth understanding of the experiences and needs of FoP in patients after OHS is beneficial for healthcare providers to make optimal decisions, but this has not been reported. We aimed to explore the experiences and needs of FoP in patients after OHS by adopting a qualitative interview method.

METHODS

A qualitative study was performed to recruit 18 qualified patients through purposive sampling and then conduct face-to-face, semi-structured interviews. The research setting was the cardiovascular surgery ward of a tertiary hospital in Guangdong, China, in 2024. The data were analyzed and extracted using conventional content analysis.

RESULTS

In the study, four themes emerged: a) sources of FoP; b) effects of FoP; c) attitudes towards FoP; d) supportive service needs. The desire to obtain meaningful assistance and the profound experiences of FoP in patients after OHS gave rise to these themes.

CONCLUSIONS

FoP following OHS is a subjective feeling characterized by fear and discomfort. Care workers must completely grasp the patients' fear and provide personalized interventions to support them through the difficult recovery phase, which will also be the focus of future efforts in this area.

The effect of missed care on the nursing image perceived by patients and their trust relationships with nurses

BACKGROUND

Missed care has negative consequences for patients, directly affecting the quality of nursing care and patient safety.

AIM

This study investigated the effect of missed care on the nursing image perceived by patients and their trust relationships with nurses.

METHODS

This descriptive and correlational study was conducted in all inpatient wards of a hospital in southern Türkiye. The sample consisted of 200 patients. Data were collected using a patient information form, the MISSCARE Survey-Patient, the Nursing Image Scale (NIS), and the Trust in Nurses Scale (TNS). The data were analyzed using the Statistical Package for Social Sciences (for Windows 25.0). The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

FINDINGS

Participants had a mean MISSCARE Survey-Patient, TNS, and NIS score of 2.09 ± 0.53, 23.48 ± 5.01, and 71.52 ± 6.75, respectively. There was a moderate negative correlation between MISSCARE Survey-Patient and TNS scores. There was a weak negative correlation between MISSCARE Survey-Patient and NIS scores. Moreover, there was a strong positive correlation between NIS and TNS scores.

DISCUSSION

MISSCARE Survey-Patient total scores vary due to the imbalance in the number of nurses and the complexity of their tasks. Poor quality of care and incomplete care undermine the image of nursing and negatively affect the trust relationship between patients and nurses.

CONCLUSIONS

Nursing image and trust in nurses decreases as patient-nurse communication and basic care interventions are skipped.

IMPLICATIONS FOR NURSING POLICY

Inadequate care can have a detrimental effect on the nursing image and erode patient-nurse trust relationships. Therefore, there is a pressing need for ongoing review and enhancement of nursing education, policy, and practice to elevate the quality of care provided. Further research utilizing objective staff measures and outcome assessments, along with gathering primary data directly from patients, is essential to substantiate the assertion that missed care significantly influences patient outcomes.

Perceptions of adult intensive care unit patients regarding nursing presence and their intensive care experiences: A descriptive-correlational study

AIMS AND OBJECTIVES

This study aims to determine the relationship between perceptions of nursing presence and intensive care experiences in adult intensive care unit patients'.

BACKGROUND

Intensive care units (ICUs) are settings where patients have many negative emotions and experiences, which affect both treatment and post-discharge outcomes. The holistic presence of nurses may help patients turn their negative emotions and experiences into positive ones.

DESIGN

A descriptive-correlational design was used and reported according to the STROBE checklist.

METHODS

The sample consisted of 182 participants. Data were collected using a personal information form, the Glasgow Coma Scale (GCS), the Intensive Care Experience Scale (ICES), and the Presence of Nursing Scale (PONS).

RESULTS

A strong positive correlation existed between total ICES and PONS scores (r = 0.889, p < 0.001). There was a strong positive correlation between PONS total score and ICES subscales (awareness of surroundings (r = 0.751, p < 0.001), frightening experiences (r = 0.770, p < 0.001), recall of experience (r = 0.774, p < 0.001), and satisfaction with care (r = 0.746, p < 0.001)). Males (β = -0.139, p < 0.05), and patients who were university and higher education graduate (β = 0.137, p < 0.05) had higher positive ICU experiences. It was also found length of ICU stay was correlated with ICU experiences and nursing presence.

CONCLUSIONS

The more positively the patients perceive nurses, the better ICU experiences they have. Gender and education level were found determinants of adult ICU patients' experiences. ICU length of stay predicted what kind of experience patients have and how much they feel the presence of nurses.

RELEVANCE TO CLINICAL PRACTICE

Nurses should make their presence felt completely and holistically by using their communication skills for patients have more positive intensive care experiences. Nurses should consider variables which affects patients' ICU experiences and nursing presence.

Pain perception of patients in intensive care unit after cardiac surgery: A qualitative study using Roy's Adaptation Model

BACKGROUND

Although research on postoperative pain has increased, postoperative pain management is still a problem today. Most patients experience moderate to severe pain after cardiac surgery. As a result of pain, patients show inefficient adaptation behaviour in physiologic, role function, self-concept, and interdependence modes.

AIM

This study was conducted to examine the pain perceptions of intensive care patients after cardiac surgery according to Roy's Adaptation Model (RAM).

STUDY DESIGN

A qualitative design with a phenomenological approach was used in the study. The research data were collected by using a "descriptive information form", a "semi-structured interview form", and the "numerical rating scale" through the "in-depth interview method". The study sample consisted of 16 patients who were aged 18 years or older, had undergone cardiac surgery, experienced pain post-operatively in the intensive care unit at least once, and had intensive care experience. Patients with neuropathic or chronic pain or neurological or psychiatric disorders were not included in the study. Data were classified into physiologic, self-concept, and interdependence modes according to RAM.

RESULTS

The themes and sub-themes that emerged included physiologic modes (pain responses), self-concept modes (pain self-management), role-function modes (effects of pain), and interdependence modes (support systems in pain).

CONCLUSIONS

The results of our study can enable patients and nurses to communicate effectively about pain. In future studies, the effect of model-based pain management programs on cardiac surgery patients can be investigated.

RELEVANCE TO CLINICAL PRACTICE

Examining the pain perceptions of intensive care patients after cardiac surgery according to RAM will guide the improvement and development of pain management. It is thought that the model addresses intensive care patients experiencing pain holistically.

Perspectives of patients, families and nurses on pain after cardiac surgery: A qualitative study

BACKGROUND

Post-cardiac surgery pain affects patients, family caregivers and nurses. The pain experiences of patients, caregivers and nurses remain largely unknown. Therefore, it is important to examine the experiences of patients, caregivers and nurses in depth to ensure effective pain management.

AIM

The aim of this study is to examine post-cardiac surgery pain from the perspectives of patients, caregivers and nurses.

STUDY DESIGN

A descriptive qualitative research design was used. The study was carried out in the cardiovascular surgery ward of a tertiary hospital in Türkiye between June and December 2022. The data-driven triangulation method was used in the research. The study sample consisted of eight patients who had undergone cardiac surgery in the tertiary hospital, eight family caregivers and nine nurses who provided care for these individuals. A 'semi-structured interview form' was used to collect data through face-to-face and in-depth interviews. The data were analysed using the thematic analysis method. The COREQ checklist was used for reporting the study.

RESULTS

As a result of the interviews, six themes were elicited from the data. These themes were 'explaining pain', 'assessment of pain', 'responses to pain', 'effect of pain on activities of daily living', 'expectations in painful situations' and 'pain management'.

CONCLUSIONS

This study revealed the differences between pain perceptions and coping processes of patients who experienced pain after cardiac surgery, their caregivers and nurses.

RELEVANCE TO CLINICAL PRACTICE

Considering the experiences of patients, caregivers and nurses in pain management after cardiac surgery, applications that will ensure joint participation in care practices should be planned.

The correlation between death anxiety, loneliness and hope levels in patients treated in the cardiac intensive care unit

BACKGROUND

A sense of hope plays an important role in relieving stress and psychological distress of cardiology patients, as well as improving their physical well-being.

AIM

The aim of this study is to investigate the correlation between death anxiety, loneliness and hope levels in patients receiving treatment in a cardiac intensive care unit (ICU).

DESIGN

This is a prospective, descriptive and correlational study.

METHODS

The study was completed with 150 cardiac ICU patients in Istanbul, Turkey. The data were collected using a Patient Information Form, the Templer Death Anxiety Scale (TDAS), the Herth Hope Index (HHI) and the UCLA Loneliness Scale (UCLA-LS).

RESULTS

The patients had a mean age of 63.56 ± 12.74 years. Most of the patients (82%) were treated in the ICU for heart failure. There was a statistically significant positive correlation between total scores of TDAS and UCLA-LS (r = .337; p < .001) and a statistically significant negative correlation between total scores of UCLA-LS and HHI (r = -.292; p < .001). Also, there was a statistically significant negative correlation between the scores of UCLA-LS and Positive Readiness and Expectancy Subscale (r = -.164; p = .044). The multiple linear regression indicated that the model was statistically significant (F = 7.177, p < .001). The variables of age and UCLA-LS among those included in the model were statistically significant predictors of the death anxiety scores of the patients (23.1%) (p < .05).

CONCLUSIONS

The cardiology patients who received treatment in the ICU had a high level of death anxiety and moderate levels of loneliness and hope. The age and loneliness level were statistically significant predictors of death anxiety.

RELEVANCE TO CLINICAL PRACTICE

It is recommended that individualized nursing care be planned and provided to conscious cardiology patients who are treated in the ICU, considering their age and loneliness levels and that nursing care be planned for individuals who are at risk of fear, anxiety, loneliness and hopelessness by periodically assessing their death anxiety, loneliness and hope levels.

Factors Affecting Death Anxiety in Patients Undergoing Open Heart Surgery: A Cross-Sectional Study

After the operation, death anxiety of patients is affected by many factors. This study aims to investigate the factors affecting death anxiety of patients undergoing open heart surgery. A descriptive, cross-sectional study. Data were collected using the 'Introductory Information Form,' the 'Templer's Death Anxiety Scale,' and the 'Spiritual Well-being Scale.' This study was conducted with 313 intensive care patients. The mean scores of the patients on the "Death Anxiety Scale" were moderate (7.96 (4.28)). According to the study findings, age, gender, length of stay in the intensive care unit, and spiritual well-being were found to be important predictors of death anxiety (F (4,308) = 16.149, p < .001). Considering gender differences in nursing care, it is thought that the intensive care period will be shortened, the level of spiritual well-being will increase and death anxiety will decrease.

Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study

OBJECTIVE

to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not.

METHOD

a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not.

RESULTS

67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures.

CONCLUSION

the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study

OBJECTIVE

to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not.

METHOD

a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not.

RESULTS

67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures.

CONCLUSION

the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Intensive Care Experiences of Postoperative Patients

Objective: The aim of this study is to examine the intensive care experience of postoperative patients. Methods: This descriptive study was conducted between February and May 2021 with the participation of 75 surgical intensive care patients. Data were collected using the patient identification form and The Intensive Care Experiences Scale (ICES). Shapiro-Wilks test, Mann-Whitney U, Kruskal-Wallis H test, Bonferroni Corrected Mann-Whitney U test, and Spearman correlation analysis were used in analyzing the data. Results: The mean patient age was 62.8 ± 14.9 year (min: 23 and max: 95); 53.3% (n = 40) were male. The patients’ mean length of stay in the intensive care unit was 1.4 ± 1.0 days. The mean ICES score of the patients was 57.4 ± 3.9. It was found that the patients’ mean scores of the “satisfaction with care” subscale varied according to the surgical procedure applied, connection to mechanical ventilation, and status of seeing other individuals receiving treatment. Conclusions: Patients’ intensive care experiences were partially positive. Being aware of the patients’ experiences, supporting them in biopsychosocial aspects, and being in contact will contribute to the improvement of their postsurgical intensive care experience.

Effect of Intensive Psychological Nursing Intervention on HAMD and SF-36 Scores in Patients with Severe Liver Cancer in ICU

The aim of the study was to explore the effect of intensive psychological nursing intervention on HAMD and SF-36 scores in patients with severe liver cancer in intensive care unit (ICU). 134 critically ill patients with liver cancer in ICU who underwent resection of primary liver cancer from July 2019 to November 2021 were selected. The patients were randomly divided into control group and study group. The patients in the control group received routine nursing. The patients in the study group received intensive psychological nursing intervention on the basis of routine nursing. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and the MOS 36-item short-form health survey (SF-36) scores before and after nursing were compared between the two groups. The satisfaction of the two groups of patients with nursing was counted. The HAMA, HAMD, and SF-36 scores of patients receiving intensive psychological nursing intervention were significantly better than those receiving routine nursing. The nursing satisfaction of patients receiving intensive psychological nursing intervention was significantly higher than that of patients receiving routine nursing. Intensive psychological nursing intervention for patients with severe liver cancer in ICU can significantly reduce HAMD, improve SF-36 score, and patient nursing satisfaction. It is worthy of wide clinical promotion.

Evaluating the impact of personalized rehabilitation nursing intervention on postoperative recovery of respiratory function among thoracic surgery patients: A protocol for systematic review and meta-analysis

BACKGROUND

Owing to clinical developments and economic strain, perioperative care has undergone considerable changes. Therefore, it is important to review and critique the efficacy of existing practices in a context that is placing increasing emphasis on better efficacy and cost-containment. Considering that the objective involves devising approaches to minimize postoperative complications and reduce medical care, efforts should concentrate on postsurgical pulmonary complications that are common. The present analysis aims to examine how customized rehabilitation nursing intercession impacts the postsurgical restoration of respiratory functions in thoracic surgery patients.

METHODS

Prespecified search strategies will be employed to perform a methodological search of 6 databases namely EMBASE, Cochrane Library, PubMed, Web of Science, WanFang Database, and China National Knowledge Infrastructure. The analysis will comprise original publications that evaluated how personalized rehabilitation nursing intervention impacts postsurgical restoration of respiratory function in those who have undergone thoracic surgery. All considered publications are before December 25, 2021. Different authors will conduct an independent study selection process to evaluate the quality of the publications and extract required data. Based on the standardized mean difference and its 95% confidence interval, we estimate the summary effects for each meta-analyses. Based on heterogeneity in considered articles, the related data will be pooled through either a random- or fixed-effect meta-analysis. Lastly, the overall quality of evidence using appropriate methods will be performed.

RESULTS

The results of this analysis will systematically evaluate how customized rehabilitation nursing interference impact postsurgical healing of respiratory functions in patients who have undergone thoracic surgery by collecting the existing evidence.

ETHICS AND DISSEMINATION

Not required.

OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER

10.17605/OSF.IO/NBVYW.

Evaluating the impact of personalized rehabilitation nursing intervention on postoperative recovery of respiratory function among thoracic surgery intensive care unit patients: A protocol for systematic review and meta-analysis

BACKGROUND

Exercise tolerance and lung function can be improved by pulmonary rehabilitation. As a result, it may lower thoracic surgery intensive care unit (ICU) patients' postoperative problems and death. Enhanced recovery after surgery has advanced significantly in the perioperative care of thoracic surgery ICU patients in recent years, and it now plays an essential role in improving ICU patients' postoperative prognosis. Appropriate tailored rehabilitation nursing intervention is required to promote the postoperative recovery of respiratory function in thoracic surgery ICU patients. This study aims to look at the influence of tailored rehabilitation nurse intervention on postoperative respiratory function recovery in thoracic surgery ICU patients.

METHODS

To find relevant papers, a comprehensive search of electronic databases will be conducted, including three English databases (PubMed, EMBASE, and the Cochrane Library) and two Chinese databases (Chinese National Knowledge Infrastructure and WanFang). Only research that has been published in either English or Chinese will be considered. The retrieval period will run from November 2021 to November 2021. We will look at randomized controlled trials (RCTs) studies that looked at the effect of a customized rehabilitation nursing intervention on the recovery of respiratory function in thoracic surgery ICU patients after surgery. Two writers will review the literature, retrieve study data, and assess the included studies' quality. Any disagreements will be settled via consensus. RevMan 5.3 will be used to do the meta-analysis.

RESULTS

This research will offer high-quality data on the influence of customized rehabilitation nurse intervention on postoperative respiratory function recovery in thoracic surgery ICU patients.

CONCLUSION

This study will look at whether a targeted rehabilitation nurse intervention might help thoracic surgery ICU patients recover their respiratory function more quickly after surgery.

ETHICS AND DISSEMINATION

There will be no need for ethical approval.

REGISTRATION NUMBER

December 12, 2021.osf.io/9rdu2/ (https://osf.io/9rdu2/).

Perceived Severity of Stressors in the Intensive Care Unit: A Systematic Review and Semi-Quantitative Analysis of the Literature on the Perspectives of Patients, Health Care Providers and Relatives

The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from 1989 to 15 May 2020. Data were analyzed with descriptive and semi-quantitative methods to yield summarizing ranking lists of the most severe stressors. We synthesized the results of 42 prospective cross-sectional observational studies from different international regions. All investigations had assessed patient ratings. Thirteen studies also measured HCP ratings, and four studies included ratings of relatives. Data indicated that patients rate the severity of stressors lower than HCPs and relatives do. Out of all ranking lists, we extracted 137 stressor items that were most frequently ranked among the most severe stressors. After allocation to four domains, a group of clinical ICU experts sorted these stressors with good to excellent agreement according to their stress levels. Our results may contribute to improve HCPs' and relatives' understanding of patients' perceptions of stressors in the ICU. The synthesized stressor rankings can be used for the development of new assessment instruments of stressors.

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

OBJECTIVES

To 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.

METHODS

Cross-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).

RESULTS

Comfort 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).

CONCLUSION

Family 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.