Caregiver burden and emotional wellbeing in informal caregivers to ICU survivors-A prospective cohort study.

BACKGROUND: Informal caregivers to intensive care unit (ICU) survivors may develop post-intensive care syndrome family (PICS-F), including depression, anxiety and post-traumatic stress (PTS). Our primary aim was to investigate associations between caregiver burden in informal caregivers cohabiting with ICU survivors and patients' physical and psychological outcomes. METHODS: A prospective, multicentre cohort study in four ICUs in Sweden. Adults cohabiting with ICU patients included in a previous study were eligible for inclusion. Three months post-ICU, informal caregivers received questionnaires assessing caregiver burden, health-related quality of life (HRQL) and symptoms of depression, anxiety and PTS. In parallel, patients reported their three-month physical and psychological status via validated questionnaires. The primary outcome of this study was to compare caregiver burden in informal caregivers to patients with and without adverse physical and psychological outcomes 3 months post-ICU. Secondary outcomes were correlations between caregiver burden and informal caregivers' mental HRQL. RESULTS: Among 62 included informal caregivers, 55 (89%) responded to the follow-up questionnaires. Caregiver burden was higher among informal caregivers to patients with an adverse outcome, compared to informal caregivers to patients without an adverse outcome, caregiver burden scale score mean (±standard deviation) 52 (11) and 41 (13) respectively (p = 0.003). There was strong negative correlation between caregiver burden and informal caregivers' mental HRQL (rs -0.74, p < 0.001). CONCLUSION: Informal caregivers to ICU survivors with adverse physical or psychological outcome experience a higher caregiver burden. A higher caregiver burden correlates with worse caregiver mental HRQL. ICU follow-up programs should consider screening and follow-up of informal caregivers for mental health problems.

The Development of the Innovation Readiness Inventory: An Assessment Tool to Assess Innovation Readiness of Nursing Organizations.

Nursing organizations are expected to make contributions to innovation in Healthcare. However, they are often not innovation ready. How do nursing organizations know how Innovation Ready they are? What should nursing organizations do to become more Innovation Ready? In literature, there exists no consolidated resource to help nursing organizations to answer these questions. Therefore, this research aimed to support nurse-led innovation by developing an Innovation Readiness Inventory to be used as an assessment tool to qualitatively assess the innovation readiness of nursing organizations and support decision-making on actions to be implemented towards innovation readiness. The researchers performed a literature review to provide the theoretical basis for the assessment tool. Thereafter, the researchers engaged innovation experts and end-users in the form of nurse directors and managers, and frontline nurses. The researchers conducted semi-structured interviews, surveys, and design workshops and performed directed qualitative content analysis where relevant. Throughout, emphasis was placed on the scientific rigor of the research methodology with the intent to ensure the "trustworthiness" of the outcomes. To this end, the researchers implemented published best practices, when relevant and appropriate. As contribution to the discussion around nurse-led innovation, this research delivers the innovation readiness inventory that focusses the discussion on nursing organizations and the nurses within, and discusses challenges and opportunities related to the use thereof.

Patient's self-determination in intensive care-from an action- and confirmation theoretical perspective. The intensive care nurse view.

When becoming an intensive care patient life changes dramatically. In order to save life, different actions are performed by the caregivers and the patient's ability to exercise self-determination is non-existent. After the acute phase the patient is more awake and the possibilities for self-determination change. The purpose of this study was to describe intensive care nurses' (ICNs) views of patient's self-determination in an intensive care unit and to systematize ICNs' nursing actions for supporting patient's self-determination from an action- and confirmation-theoretic perspective. In order to answer these questions, 17 interviews with ICNs were conducted by the use of the Critical Incident Technique (CIT). The transcripts were then analysed using a hermeneutic analysis method and structured by the SAUC model for confirming nursing. The main findings were that the ICN thought that the ICU patient's self-determination was low and restricted. It was more common that the ICN acted to strengthen the patient's self-determination in nursing care, but there were no specific nursing goals for patient's self-determination. The most common actions for supporting self-determination were supplying the patient with information and engaging the patient in making a day plan. The nursing implications are that the ICN's view of human being as an acting subject is important for the ICN's awareness to recognise the patient's own personal resources to handle the critically ill situation and that the ICN's competence to manifest qualified nursing is necessary for strengthening patient's self-determination.