Browsing by Author "Moss, Stephana Julia"

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    Caring for the Critically Ill
    (2021-09-21) Moss, Stephana Julia; Bobawsky, Kirsten Marie; Stelfox, Henry Thomas; Doig, Christopher James; Patten, Scott Burton
    Family or informal caregivers are key to the delivery of patient-centered care and often act as patient advocates. Visitation from family caregivers in the intensive care unit (ICU) can have long-term impacts on ICU patients post-hospital discharge. A relationship between exposure to critical illness and negative psychological sequalae among family caregivers of critically ill patients is consistently reported. The literature on mental health interventions to improve psychological outcomes in family caregivers of the critically ill has not been appraised. Bereavement interventions in the ICU have not been mapped to core outcomes for evaluating bereavement support among family caregivers. The effect of family visitation on ICU survivors post-discharge psychiatric outcomes is unknown. Perspectives from designated family caregivers during the coronavirus disease 2019 (COVID-19) pandemic have not been well characterized. The work reported in this thesis addresses these knowledge gaps. Based on a systematic review of 102 trials, mental health interventions reduced anxiety (Ratio of Means (RoM), 0.92; 95% confidence interval (CI): 0.87–0.97) and depression (RoM, 0.83; 95%CI: 0.69–0.99), but not post-traumatic stress disorder (RoM, 0.91; 95%CI: 0.80–1.04) or distress (RoM, 1.01; 95%CI: 0.95–1.07) among family caregivers within 3-months post-discharge. Increased burden among family caregivers within 3-months post-discharge (RoM, 1.08; 95%CI: 1.05–1.12) was observed. Three studies of ICU bereavement interventions indicated that available trial evidence is sparse and does not support use of bereavement interventions for family caregivers of patients who die in ICU. Using administrative databases, it was found that ICU family visitation was associated with decreased risk for psychiatric disorders (risk ratio (RR), 0.87; 95%CI: 0.79-0.97), mainly trauma- and stressor-related disorders (RR 0.66; 95%CI: 0.38-0.87), in ICU survivors up to one-year post-discharge. In COVID-19, designated family caregivers of critically ill patients perceived emotional distress related to being the only family member allowed to visit. The results of these studies characterize the impact of a family-centered care approach in the ICU on caring for the critically ill, which is integrated into recommendations for the field.