Risk factors associated with transfer anxiety among patients transferring from the intensive care unit to the ward.

AIM: This paper is a report of an examination of the effect of risk factors on the development of transfer anxiety in patients being transferred from the intensive care unit to the ward. BACKGROUND: Transfer of a patient from the intensive care unit to the ward could lead to transfer anxiety, a type of separation anxiety associated with transfer from a secure and familiar environment to an unfamiliar one. Previous studies have demonstrated associations between hospital anxiety and demographic, clinical and social factors. METHOD: Data were collected from 100 patients who were transferred from intensive care unit to the ward, using medical records and three self-report questionnaires (Hospital Anxiety and Depression Scale, Medical Outcomes Study-Social Support Scale, Health Care System Distrust Scale), completed within 72 hours of transfer, between 2005 and 2006. Spearman Rho correlations were used to determine relationships between variables. FINDINGS: A statistically significant relationship was found between amount of social support (r(s)=-0.21, P=0.04), length of intensive care unit hospitalization (r(s)=0.21, P=0.04) and gender (U=907.0, P=0.03) with transfer anxiety. No statistically significant relationships were found between transfer anxiety and other factors. CONCLUSION: Nurses should be especially aware of an increased risk for transfer anxiety among women, and those with lower social support and longer intensive care unit length of stay. We recommend that interventions, especially targeted to these populations, be developed to decrease its prevalence.

Characteristics of patients receiving vasopressors.

BACKGROUND: Patients receiving intensive care frequently need pharmacologic support of their blood pressure because of shock. In some patients, shock is so severe that extremely high doses of vasopressors are needed to elevate their blood pressure. OBJECTIVE: We sought to ascertain the maximal dose of vasopressors administered to patients, and to describe the population of patients receiving vasopressors in one intensive care unit. METHODS: All adult patients admitted in 2001 to a 10-bed surgical unit in a university hospital, and receiving a vasopressor agent for 1 hour or more, underwent recordings of their demographic data, diagnoses upon admission, Acute Physiological and Chronic Health Evaluation (APACHE) II scores, vasopressors (including type, initial dose, dose increases, and maximal dose), number of days administered, complications, and mortality. RESULTS: Of 689 patients whose charts were reviewed, 72 received vasopressors. The mean age was 65 ± 21.4 years, and 66% were male. The mean APACHE II scores were 24 ± 6.2. The administration of .5 µg/kg/minute of norepinephrine or epinephrine resulted in 96% sensitivity and a specificity of 76% for the likelihood of mortality. Using Kaplan-Meyer curves, those patients receiving less than .5 µg/kg/minute demonstrated an 80% 6-year survival. All 17 patients receiving more than 3.8 µg/kg/minute of norepinephrine, and all 5 patients receiving more than 9.6 µg/kg/minute of epinephrine, died. The length of time during which patients received less than their maximal dose of vasopressors had no influence on survival (P = .4). The elderly (aged ≥ 75 years) and the young (aged <75 years) had the same intensive care unit survival rates when receiving vasopressors. CONCLUSION: In this study, little likelihood of intensive care unit survival was evident when patients received more than .5 µg/kg/minute of norepinephrine or epinephrine.