Effects Of An Evidence-based Intervention On Stress And Coping Of Families Of Critically Ill Trauma Patients

Problem/Purpose: Critical care nurses are frequently exposed to the stress experienced by their patients\u27 families, yet they often do not have the knowledge or skills to help family members cope with the stress of critical illness. While needs and stressors of families of the critically ill have been researched extensively, no prior studies have been conducted to determine the effects of an evidence-based nursing intervention for reducing family members\u27 stress and improving their coping skills. The purpose of this study was to determine if an evidence-based nursing intervention designed to address the needs of family members would reduce stress and improve coping skills in family members of critically ill trauma patients. Additionally, the study assessed the family members\u27 perceptions of how well their needs were met while their loved one was hospitalized in the surgical intensive care unit (SICU). Methods: Using a quasi-experimental, nonequivalent control group design, an evidence-based intervention for critical care nurses was implemented to test its effect on stress and coping of family members of critically ill trauma patients. The study setting was the SICU at a tertiary university hospital in north central Florida. Subjects were family members of critically ill trauma patients who had been hospitalized in the SICU for at least 48 hours. Participants in the control group were given a packet containing instruments that measured 1) anxiety as an indicator of stress (Spielberger\u27s State-Trait Anxiety Inventory ); 2) coping (Lazarus and Folkman\u27s Ways of Coping Questionnaire ); and 3) assessment of family members\u27 perception of having their needs met while their family member was in the SICU (Family Care Survey ). An evidence-based family bundle was implemented over an eight-week period and included an educational program for the nurses. After eight weeks, participants in the experimental group were given the same instruments previously administered to the control group. Anxiety levels, coping skills, and family members\u27 perception of having needs met were compared between the two groups to determine the effectiveness of the evidence-based intervention. Results: A total of 84 family members participated in the study (control = 39; experimental = 45). The majority were women (n=60), spouse or parent of the patient (n=47), and Caucasian (n=70). Mean ages were 45.9 years for the control group and 47.4 years for the experimental group. No differences were noted in the demographic characteristics between the control and experimental groups. Using an independent samples t-test, no significant differences (p \u3e .05) were noted between groups for either state or trait anxiety, although the mean anxiety score was lower in the experimental group. Significant differences between groups were noted on two of the eight coping subscales: Distancing and Accepting Responsibility. Improved coping, although not statistically significant, was noted on four additional subscales: Confrontive Coping, Self-Controlling, Planful Problem-Solving, and Positive Reappraisal. Overall coping scores also improved, but not statistically, for the total Ways of Coping Scale (both 50 and 66 item totals). Although not statistically significant, participants in the experimental group rated four out of eight items higher on the FCS, indicating an increased perception that more of their needs were met, greater overall satisfaction with the care that family members received, increased nurses\u27 consideration of family members\u27 needs and the inclusion of those needs in planning nursing care, and greater encouragement for family members to participate in care. Although findings were not statistically significant, the trend implies increased satisfaction with family care in areas involving family care and family member needs, including needs in planning care and encouragement to participate in care. In areas regarding information and communication, there was overall less satisfaction in both groups. Conclusions: This study provides data that can be used as a guide in developing programs that help families function and adapt to the extremely stressful experience of having a loved one who is critically ill. The information can be used to develop future research on larger scales with a longer and more extensive plan for implementation of the intervention to assist in a unit culture change. Nurses can use the results to facilitate practice changes in caring for families of critically ill patients. Modifying the interventions to focus on an interdisciplinary approach to meet families\u27 needs, reduce stress, and improve coping also warrants further development and testing. Funding acknowledgement: Florida Nurses Foundation and the American Association of Critical Care Nurses. College of Nursing, University of Central Florid