Η επίδραση των ψυχολογικών διακυμάνσεων του οικογενειακού περιβάλλοντος ασθενών της ΜΕΘ στην αξιολόγηση του ιατρονοσηλευτικού προσωπικού

Abstract

Introduction: Patient’s admission in ICU is often a stressful event for patient’s family. Symptoms of anxiety and depression can occur in family members of the patients and affect the way relatives conceive the whole situation. This is the reason why the ICU staff has to evaluate and fulfill the needs of patients’ relatives in order to soften their pain, provide supportive care during difficult situations and make easier for them the hospitalization of their beloved person in ICU. The evaluation of family needs provides staff with useful information in order to improve family satisfaction and also helps doctors and nurses to provide care in patients, according to their families’ wish. Aim of the study: To evaluate symptoms of anxiety, depression and post traumatic stress disorder (PTSD) in families of ICU patients, and also to evaluate the relation between these symptoms and a) family satisfaction with patient care, b) family satisfaction with decision making and c) total family satisfaction. Methods: A prospective study, with repeating measurements, in which 102 family members (62 female and 40 male), between 19-82 years old (mean age: 48,5±14,9), of patients in ICU at a large public hospital in Athens participated. The questionnaires of the study were distributed to the relatives from August 2008-August 2010 and always after doctors’ informing them about patient’s condition. Three scales were used: a) HADS (Hospital Anxiety and Depression Scale), in order to evaluate symptoms of anxiety and depression, b) IES-R (Impact of Event Scale-Revised), a very useful tool in order to evaluate the degree some stressful events (pleasant or unpleasant) affect people’s everyday life and c) FS-ICU 24 scale (Family Satisfaction in the Intensive Care Unit-24), that measures family satisfaction with care and family satisfaction with decision making. Two measurements took place: The first one 7-10 days from the admission of the patient in the ICU and the second one (to the same relative) after 15-20 days from the admission. Patients’ health condition was evaluated with the A.P.A.CH.E II (Acute Physiology and Chronic Health Evaluation II) score before each measurement. The criterion for the supplementation of the questionnaire was the patient to be intubated for 48 hours at least and the relative have visited him for two times in a row, for more than 10 minutes. Results: 62% of the relatives face severe symptoms of anxiety, over 50% face severe symptoms of depression and almost 68% severe symptoms of post traumatic stress disorder (PTSD). Symptoms of anxiety and depression were related with symptoms of PTSD in relatives (p<0,05), but no relation was found between these symptoms and patient’s health condition, according to APACHE II score (p>0,05). Family satisfaction with care (mean score) was diminished from 76 in first measurement, to 71 in second measurement (p<0,05). The level of family satisfaction with decision making was invariable between two measurements and mean scores were about 70 (p>0,05). Mean scores about total satisfaction fluctuated between 71-72 during the first and the second measurement too, with no statistically important variation (p>0,05). No correlation was found between symptoms of anxiety-depression –PTSD, and family satisfaction with care (p>0,05). On the contrary, family satisfaction with decision making and total satisfaction was correlated with symptoms of anxiety in patient’s relatives (p<0,05). Conclusions: Relatives of ICU patients face severe symptoms of anxiety, depression and PTSD during the whole stay of patients in ICU. The majority considers patient’s hospitalization in ICU as a stressful event that has unsettled everyday life and tries to avoid it. These symptoms seem not to particularly affect the level of family satisfaction; nevertheless, the ICU staff must retrace, evaluate and confront them in order severe future psychological problems to the relatives be prevented.