TY - JOUR
T1 - Factors affecting stress experienced by surrogate decision makers for critically ill patients
T2 - Implications for nursing practice
AU - Iverson, Ellen
AU - Celious, Aaron
AU - Kennedy, Carie R.
AU - Shehane, Erica
AU - Eastman, Alexander
AU - Warren, Victoria
AU - Freeman, Bradley D.
N1 - Funding Information:
This research was supported by the National Institutes of Health ( 1 R01 GM080591 ), “Establishing an Ethical Framework for Critical Care Genetics.” The authors would like to acknowledge our appreciation to Carie Kennedy, RN, Victoria Warren, RN and Mandy Oerke, RN, who spearheaded study recruitment in St. Louis and Dallas and the support of our partners Brian Clarridge, PhD, and Dragana Bolcic-Jankovic, MA, from the University of Massachusetts, Center for Survey Research. Finally, we would like to thank our study participants for offering their time and thoughtful contribution under such challenging circumstances.
PY - 2014/4
Y1 - 2014/4
N2 - Objectives: This study explores surrogate decision-makers' (SDMs) challenges making decisions related to the care of patients in critical care, to (1) characterise the SDM stress, (2) identify personal, social, care-related factors influencing stress and (3) consider implications of findings to improving critical care practice. Methodology: Semi-structured interviews were conducted with SDMs of critically ill patients receiving care in two tertiary care institutions. Transcripts were analysed using a grounded theory approach. Domains explored were: stress characteristics, stress mitigators, coping strategies, social networks, SDM decision-making role, decision-making concordance, knowledge of patient's preferences, experience with provider team, SDM-provider communication, patient outcome certainty. Main outcomes: We interviewed 34 SDMs. Most were female and described long-term relationships with patients. SDMs described the strain of uncertain outcomes and decision-making without clear, consistent information from providers. Decision-making anxiety was buffered by SDMs' active engagement of social networks, faith and access to clear communication from providers. Conclusion: Stress is a very real factor influencing SDMs confidence and comfort making decisions. These findings suggest that stress can be minimised by improving communication between SDMs and medical providers. Nurses' central role in the ICU makes them uniquely poised to spearhead interventions to improve provider-SDM communication and reduce SDM decision-making anxiety.
AB - Objectives: This study explores surrogate decision-makers' (SDMs) challenges making decisions related to the care of patients in critical care, to (1) characterise the SDM stress, (2) identify personal, social, care-related factors influencing stress and (3) consider implications of findings to improving critical care practice. Methodology: Semi-structured interviews were conducted with SDMs of critically ill patients receiving care in two tertiary care institutions. Transcripts were analysed using a grounded theory approach. Domains explored were: stress characteristics, stress mitigators, coping strategies, social networks, SDM decision-making role, decision-making concordance, knowledge of patient's preferences, experience with provider team, SDM-provider communication, patient outcome certainty. Main outcomes: We interviewed 34 SDMs. Most were female and described long-term relationships with patients. SDMs described the strain of uncertain outcomes and decision-making without clear, consistent information from providers. Decision-making anxiety was buffered by SDMs' active engagement of social networks, faith and access to clear communication from providers. Conclusion: Stress is a very real factor influencing SDMs confidence and comfort making decisions. These findings suggest that stress can be minimised by improving communication between SDMs and medical providers. Nurses' central role in the ICU makes them uniquely poised to spearhead interventions to improve provider-SDM communication and reduce SDM decision-making anxiety.
KW - Critical illness
KW - Provider-SDM communication, Qualitative data collection
KW - Social science research
KW - Surrogate decision maker
UR - http://www.scopus.com/inward/record.url?scp=84893694873&partnerID=8YFLogxK
U2 - 10.1016/j.iccn.2013.08.008
DO - 10.1016/j.iccn.2013.08.008
M3 - Article
C2 - 24211047
AN - SCOPUS:84893694873
SN - 0964-3397
VL - 30
SP - 77
EP - 85
JO - Intensive and Critical Care Nursing
JF - Intensive and Critical Care Nursing
IS - 2
ER -