Nursing Assignment Stressors of Family Members

Question :

the stress in the family members of the patient admitted in the ICU (intensive care unit) and how health care providers can help to relieve or manage that stress.

Answer :

1 Literature Review

In this chapter the research summary has been discussed for the stressors of family members of patients admitted in intensive care and the role of caregivers in managing that stress. In order to establish the research rationale, review of previous researches in the field have been presented in the subsections. It includes the theoretical background for the chosen research method and conceptual framework of the methods. The search strategy of the previous studies have also been mentioned and adequately cited. 

1.1 Search Strategy

As a part of secondary data collection various sources and databases have been used. Social science, nursing and medical research in this field have been considered. To ensure the credibility of the sources only those published in recognised journals and periodicals such as PubMed, International Journal of Nursing, Elsevier etc, have been used. In order to obtain relevant data research conducted before 2014 have not been used. Hence, the timeline of reference has been fixed at a maximum of five years. The current research was conducted in Spring, 2020.   

1.2 Relevant Researches

When a family member is admitted in the intensive care, families go through unimaginable amount of stress and changes in daily life. Changes in sleeping and eating habits are observed which only adds to the stress. Such mental state of the families not only the individual family members but also the patient. In the recent past, researchers have started taking an interest in the stress symptoms exhibited by the family members which might or might not lead to post traumatic stress (Rückholdt, et al., 2019). The types of stressors vary from family to family but the common patterns have been observed in cross-sectional descriptive researches. The sample size of these research populations ranges from 25 to 100 family members (Beesley, et al., 2018). A significant qualitative research conducted with 28 participants revealed some common themes which have been discussed in the next sub-section (Pourghane, et al., 2018). Research conducted by (Barth, et al., 2016)laid stress on the correlation between the patients’ APACHE II based scores and the level of family members’ anxiety. The review of family members’ cortisol levels over a period of 2 to 3 months also forms a part of associated methods in many researches (Zarei, et al., 2015). Based on qualitative and quantitative data including questionnaires the family members’ HADS Anxiety and HADS Depression scores could be identified and correlated (Stern, 2014). While many researches have been conducted to identify and manage the stressors in family members of intensive care patients not many studies talk about the importance of initiatives taken by healthcare providers to manage this stress. The healthcare providers play an important role attending to the physical and emotional needs of the patient as well as the emotional needs of the family members. The main idea is to manage the stress at both at ends so that neither can affect the other negatively. One of the studies also points out the responses of family members to the stress interventions. For example, some family members felt comfortable that their needs were being addressed with appropriate questioning whereas some felt that these added to their stress and were unnecessary (Gaeeni, et al., 2015). However, the interventions do lead to positive results and hence more research and implementations are required in this field.  

1.3 Types of Stressors in Family Members 

Following are the themes and their explanation which refer to the types of stressors in family members of intensive care patients:

Figure 1 Themes Inducing Stress in Family Members. Adapted from (Pourghane, et al., 2018)

1.3.1 Heavy Shadow of Illness

Family members feel a heavy shadow of illness which is generally caused due to feel and lack of knowledge. Firstly, they have a fear of being alone in taking care of the patients due to lack of helping hands, personal constraints like illness and job, or even the lack of support from fellow family members. Secondly, the family members often fear the disease or are worried about the patients’ surgery. This is a quite complicated set of emotions which constitutes of different types of fears such as fear of repeated hospitalizations, fear of underlying conditions such as diabetes and fear of becoming the sole caregiver for the patient due to complicated family affairs (Pourghane, et al., 2018). Finally, in addition to the fears there are two types of lack of knowledge. In few cases the family members are not literate enough to understand the disease or its critical care. In other cases, the family members stress about their lack of knowledge about the disease. For complicated illnesses like cardiac problems, family members often do not know much about critical care post discharge. 

1.3.2 Hesitation in Treatment

Often family members are found hesitant about the treatment their patient is receiving. This is mainly because of two root causes. Firstly, they have doubts about the technology that is used to treat the patients. If they have witnessed any faulty machines or machine replacements in the intensive care it is evident for them to doubt the effectiveness of the treatment. Secondly, they face emotional stress due to their negative experiences with healthcare providers. Respondents of the research reported that there was lack of empathy on part of the healthcare providers, they did not provide for the patient’s needs and the family members were also misinformed in some cases (Pourghane, et al., 2018). Positive responses such as fluent communication between healthcare providers and the patient parties have also been reported but such instances are few. 

1.3.3 Economic Issues

Financial concerns is a major cause of stress for many families. Every kind of hospital expenses are not covered by medical insurance. In fact some long-term diseases are not covered by insurance or the treatment expenses exceed the insurance limit. Expensive medicines, surgeries or long-term treatment affects the finances of the entire family. Besides these issues, there are other potential economic crises which can because a cause of anxiety. For the middle or lower income families the monthly earnings might not be enough to support the family besides taking care of the patient. If the treatment expenses are too much to bear, the families face the potential problems of rent and bill payments. Also, not all families have the privilege of living in cities. Some live in distant, remote areas which lack proper medical facilities. Hence, the family members worry that if the condition of the patient deteriorates after discharge they might not be able to handle it due to lack of facilities or they have to incur huge expenses to reach the facilities. 

1.4 Conceptual Framework

In this sub-section the concepts behind determination of the stressors and stress management techniques have been discussed as revealed by relevant researches. 

1.5 Methods of Determining Stressors

This research uses Lazarus and Folkman’s Transactional Model of Stress and Coping and HADS Anxiety and Depression Score to determine the level of stress in the family members. 

1.6 Conclusion

Intensive care is a stressful time for the patient, family members as well as the healthcare providers. In this review of literature, effort has been made to determine the stressors in family members and the steps that could be taken by healthcare providers to manage that stress. These methods could be applied in the current study to further explore the limitations of the past studies. 

2 Works Cited

Adams, J. et al., 2014. Nursing Strategies to Support Family Members of ICU Patients at High Risk of Dying. Heart Lung, 43(5), pp. 406-415.

Barth, A. et al., 2016. Stressors in the relatives of patients admitted to an intensive care unit. Rev Bras Ter Intensiva, 28(3), pp. 323-329.

Beesley, S. et al., 2018. Acute Physiologic Stress and Subsequent Anxiety Among Family Members of ICU Patients. Crit Care Med., 46(2), pp. 229-235.

Gaeeni, M., Farahani, M., Seyedfatemi, N. & Mohammadi, N., 2015. Informational Support to Family Members of Intensive Care Unit Patients: The Perspectives of Families and Nurses. Global Journal of Health Science, 7(2), p. 8–19.

Lazarus, R. & Folkman, S., 1984. Stress, Appraisal, and Coping., New York: Springer Publishing Company.

Pourghane, P., Nikfam, M. & Ebadi, A., 2018. Perceived Stressors of Hospitalized Patients’ Family in Cardiac Care Unites: A Qualitative Content Analysis.. The Qualitative Report, 23(7), pp. 1515-1529.

Rückholdt, M., Tofler, G., Randall, S. & Buckley, T., 2019. Coping by family members of critically ill hospitalised patients: An integrative review. International Journal of Nursing Studies, Volume 97, pp. 40-54.

Stern, A., 2014. Questionnaire Review: The Hospital Anxiety and Depression Scale. Occupational Medicine, Volume 64, p. 393–394.

Zarei, M., Keyvan, M. & Hashemizadeh, H., 2015. Assessing the Level of Stress and Anxiety in Family Members of Patients Hospitalized in the Special Care Units. International Journal of Review in Life Sciences, 5(11), pp. 118-122.