Impact of Prior Intensive Care Unit (ICU) Experience on ICU Patients' Family Members' Psychological Distress

Purpose:  Psychological distress including anxiety, depression, and stress in family members of intensive care unit (ICU) patients is a well-documented phenomenon across a wide variety of countries including, but not limited to, Brazil, Italy, China, Greece, France, and the United States(Chiang et al., 2016; Davidson, Jones, & Bienvenu, 2012; Fumis, Ranzani, Faria, & Schettino, 2015; Konstanti, Gouva, Dragioti, Nakos, & Koulouras, 2016; Mistraletti et al., 2016; Pochard et al., 2001) . A real clinical example of the impact a family member’s psychological distress has for nursing occurs with the comprehension of simple concepts, such as that of time. In one instance, a family was unable to grasp the concept of time when the end of a nurse’s shift occurred; yet, this same family was being asked to make crucial life or death decisions. The clinical example presented here embodies what we have learned from advances in neurobiology, which have demonstrated that humans under stress have a reduced recall capacity and recognition performance (Schwabe & Wolf, 2010).

Having a family member in the ICU goes beyond stress for some individuals, and actually leads to the development of post-traumatic stress disorder (PTSD) (Sundararajan et al., 2014). The overstimulating influence of technology present in the ICU environment has been identified as a contributing factor to anxiety in ICU patient family members (Fumis & Deheinzelin, 2009). Relatively recently, research conceptualized this persistent psychological distress experienced by family members of ICU patients as Postintensive Care Syndrome (PICS) – family (Davidson, Jones, & Bienvenu, 2012). Despite the acknowledgment that PICS - family may occur for up to four years after an ICU experience, no known research has investigated whether previous ICU experience contributes to ICU patient family members’ experiences of anxiety, depression, and stress symptoms. This particular lack of literature is intriguing when considered with the recommendation from 1996 by Jamerson et al. for nurses to assess the family members’ prior experiences with ICUs as part of the ICU education process for the family members.

As part of a multi-phase study investigating ICU family member’s experience of psychological distress, the sub-aim presented here was to determine if current levels of anxiety, depression, and acute stress disorder symptoms differ significantly among family members of ICU patients, depending upon previous ICU experience.

Methods:  This study used a prospective, descriptive study design. Data collection occurred between 2013 and 2014. Family members (n=127) from patients admitted within the past 72 hours to the medical, surgical, cardiac, and neuro ICUs were recruited from the ICU waiting rooms at a medium sized community hospital in the Southeastern United States. Participants completed the Hospital Anxiety and Depression Scale (HADS), the Impact of Events Scale-Revised (IES-R), the Acute Stress Disorder Scale (ASDS), and a demographic survey. IRB approval was granted as an expedited review.

Results:  A multivariate analysis of variance (MANOVA) revealed that family members of ICU patients who had a prior ICU experience within the past two years (n= 56) were significantly more likely to report anxiety, depression, and stress symptoms than family members of ICU patients who had not had a prior ICU experience within the past two years, Λ = .92, F [4,122] = 2.70, p = .034, partial η² = .08, observed power = .74

Conclusion: Nursing intuition suggests novice ICU family members experience more psychological distress and need more support during a family member’s ICU admission. However, the results of this study show that family member’s psychological distress is actually higher with previous ICU experience. These findings are of important consideration in light of nursing practice’s continued disregard of Jameson et al.’s (1996) recommendation for nursing to assess previous ICU experience. The ICU patient family members’ experience of psychological distress transcends a single culture or country. As a global health phenomenon, nursing needs to assess family members’ previous ICU experience when providing family-centered care for ICU patients and families and determine how the families would prefer to be supportive. In addition, collaboration with chaplain services, social services, counseling services, and patient advocates is encouraged to assist with addressing how the family member’s previous ICU experience is impacting their current psychological distress. Collaborating support professionals’ acknowledgement and normalization of family members’ psychological distress related to previous ICU experience can provide family members with a safe outlet to share openly and honestly about their affective experiences in a way that does not burden the patient. Furthermore, support professionals could facilitate support group experiences for family members with previous ICU experience to provide them with a safe group of understanding others who can provide them with support so that they may better support the patient.