Factors affecting stress experienced by surrogate decision makers for critically ill patients: Implications for nursing practice

Abstract

Objectives This study explores surrogate decision-makers’ (SDMs) challenges making decisions related to the care of patients in critical care, to 1) characterize the SDM stress 2) identify personal, social, care-related factors influencing stress and 3) consider implications of findings to improving critical care practice. Methodology Semi-structured interviews were conducted with SDMs of critically ill patients receiving care in two tertiary care institutions. Transcripts were analyzed using a grounded theory approach. Domains explored were: stress characteristics, stress mitigators, coping strategies, social networks, SDM decision-making role, decision-making concordance, knowledge of patient's preferences, experience with provider team, SDM-provider communication, patient outcome certainty. Main Outcomes We interviewed 34 SDMs. Most were female and described long-term relationships with patients. SDMs described the strain of uncertain outcomes and decision-making without clear, consistent information from providers. Decision-making anxiety was buffered by SDMs’ active engagement of social networks, faith and access to clear communication from providers. Conclusion Stress is a very real factor influencing SDMs confidence and comfort making decisions. These findings suggest that stress can be minimized by improving communication between SDMs and medical providers. Nurses central role in ICU make them uniquely poised to spearhead interventions to improve provider-SDM communication and reduce SDM decision-making anxiety.

Identifying Information Resources for Patients in the Intensive Care Unit and Their Families

“…4,5 Patients in the ICU and their families have varying abilities and willingness to participate in care and decision-making. 6 Patient education requires a flexible approach, especially with family members who become the main points of contact for decision-making on behalf of the patients.…”

Integrative Literature Review- Nursing Interventions in the Stress Control of the Family of the Sick Person in a Critical Condition

“…The management and stress control are shown as nursing intervention areas, based on meeting the special needs of the person in critical condition, as well as her family, demonstrating an important contribution to the humanization of nursing care (Rinaldi et al, 2014;Iverson et al, 2014;Knapp et al, 2013;Mercês et al, 2012;Black et al, 2011).…”

“…The nursing interventions are described in an uneven manner, framed in different moments of care to the family, as the time of hosting the family (Rinaldi et al, 2014;Knapp et al, 2013;Choi et al, 2013;Davidson, 2010;Davidson, 2009;Stayt, 2009), the family's preparation for decision-making (Khalaila, 2014;Iverson et al, 2014;Knapp et al, 2013), accompanying the family when watching the sudden clinical worsening of their relative, namely witnessing cardio-respiratory resuscitation (Rinaldi et al, 2014;Beer &Moleki, 2012;Köberich et al, 2010) and in acute cases of delirium (Black et al, 2011), and finally in the family preparation for the death of their family member (Bloomer & O'Connor, 2012;Beer &Moleki, 2012;Köberich et al, 2010;Hickman et al, 2010). According to the study by Knapp et al (2013, p.1) based on the scientific evidence a "family bundle" was created to be applied by nurses when providing care to the family of the people in critical condition, based on the five principles "Evaluate, Plan, Involve, Communicate and Support (EPICS)" that proved capable of promoting the reduction of stress, contributing to the family coping.…”

“…In relation to communication, although less evidence was found, it is noteworthy that in his speech the nurse must inform the family about the environment around the patient and should also optimize it, taking it as organized as possible before receiving a visit from the family, because it is described that the knowledge of the environment promotes positive coping, giving meaning to those aspects that scare the family (Iverson et al, 2014;Mercês et al, 2012;Davidson, 2010;Davidson, 2009), since it is through their control over the stressful situation that the family can manage stress and enhance the coping. It was proven that environmental organization gives serenity and contributes to post-traumatic stress prevention.…”

“…It was found in about 33% of the studies the need for the nurse to act in functional complementarity when he realizes that he is no longer able or competent to help the family, and so, promoting and facilitating psychological, emotional or spiritual support according to the review and analysis of the situation (Iverson et al, 2014;Knapp et al, 2013;Hickman et al, 2010;Stayt, 2009). As evidenced by Khalaila (2014), Black et al (2011) and Davidson (2009), it is important for nurses to recognize the different realities and processes of adaptation that the family has to face with the new reality.…”