Impact of hospitalisation on behavioural and physiological stress responses associated with cardiovascular risk in visiting family members.

BACKGROUND: The hospitalisation of a patient in intensive care impacts the psychological health of family members, with a high prevalence of anxiety, depression, and post-traumatic stress symptoms reported among families of critically ill patients. Understanding of the behavioural and physiological impact is limited and presents a new area of focus. OBJECTIVES: The objective of this study was to evaluate behavioural and physiological stress responses of visiting family members following hospitalisation of their adult relative. METHODS: Prospective longitudinal evaluation included 40 family members of adult patients with admission to intensive or coronary care in a large tertiary care metropolitan hospital. Assessments were conducted at three timepoints: in-hospital within 1 week of admission and 2 weeks and 3 months post discharge. Assessments included duration and quality of sleep (self-reported and actigraphy measured), physical activity, dietary and alcohol patterns, resting heart rate and blood pressure, and morning blood cortisol and lipid levels. Assessment of a reference group of 40 non-hospital-exposed control participants was also conducted. RESULTS: At the in-hospital assessment, study participants reported lower sleep time, altered 24-h physical activity patterns, reduced dietary and alcohol intake, and higher systolic and diastolic blood pressure than a nonhospitalised reference group. Compared to in-hospital assessment, these altered behavioural and physiological responses improved over time except for systolic blood pressures which remained unchanged at 3 months post family member discharge. CONCLUSION: Hospitalisation is associated with altered behavioural and physiological responses in family members. These findings contribute to understanding of the impact of unexpected hospitalisation on family members' cardiovascular risk factors and provide insights into potential mechanisms for the proposed increased risk during this time. Elevated systolic blood pressure at 3 months post discharge suggests a prolonged cardiovascular stress response in many family members of critical care patients that requires further study, with a focus on contributing and potential modifiable factors.

Psychological responses and coping behaviour of visiting family members during and following unplanned hospital admission.

AIMS: To describe the psychological symptoms and coping behaviours of visiting family members following the unplanned hospitalisation of their relative. BACKGROUND: Hospitalisation of a patient is recognised as a stressful time for visiting family members, who experience psychological morbidity and elevated health risk. DESIGN: This prospective longitudinal evaluation included 40 family members of patients with unplanned admission to coronary or intensive care. Assessments were conducted at 3 timepoints: in-hospital within 1 week of admission and again at 2 weeks and 3 months post-discharge. Measures included symptoms of anxiety, depression, and anger, coping strategies and social support. This paper adhered to STROBE guidelines. RESULTS: At the initial in-hospital assessment study participants reported higher anxiety, depression and anger symptoms levels compared to community matched control participants. Compared to in-hospital assessment, anxiety and depression levels were lower at 2 weeks and 3 months following hospital discharge. The use of active coping and the use of religion during early hospitalisation were associated with higher anxiety and depression symptoms at 3 months post-discharge. Conversely, use of instrumental support (getting help and advice from others), planning and venting during early hospitalisation were associated with lower depression symptoms at 3 months. Venting during the hospitalisation period was also associated with lower anxiety symptoms at 3 months. CONCLUSION: Results demonstrate the significant psychological impact of unplanned hospitalisation on visiting family members both during and following hospitalisation. The finding that prolonged psychological response is associated with individual coping strategies employed in the early hospitalised period informs potential preventative approaches for family members at risk of prolonged psychological morbidity following hospitalisation of their loved one. RELEVANCE TO CLINICAL PRACTICE: The reported psychological impact of hospitalisation on family members provides a strong imperative for nurses and health professionals to provide early individualised support to reduce the risk of long-term psychological morbidity.

The impact of hospitalisation on a visiting family member: A case study and discussion.

Evidence suggests that when an immediate family member of a spouse is hospitalised, the partner's risk of death significantly increases. Hospitalisation can represent a time of great vulnerability and imposed stress for both the patient and their family members. Family members have been reported to give priority to the welfare of their ill relative and in their heightened emotional state, often adversely put their own health at risk. The paper presents a case study highlighting how an intensive care hospitalisation and discharge to rehabilitation experience for a patient's mother triggered an episode of myocardial infarction for her adult son. Discussion focuses on the caregiving burden and potential mechanisms for how hospitalisation may contribute to the health risk of immediate family members of hospitalised patients. Discussion also highlights the importance of family members receiving clear, continuous and consistent information from a limited number of clinicians to help reduce the stress associated with caregiving during acute hospitalisation.

Coping by family members of critically ill hospitalised patients: An integrative review.

OBJECTIVES: To provide a comprehensive integrative review of research literature on 1) the coping strategies that are reported by adult family members following admission of their adult loved ones to the intensive care unit (ICU), 2) identify which coping strategies are associated with psychological response during this stressful experience, and 3) the factors that are associated with coping strategies. DATA SOURCES: Electronic databases: MEDLINE, PubMed, CINAHL, PsycINFO, and EMBASE; reference lists of journal publications. REVIEW METHODS: A total of 643 citations or abstracts were initially screened for content relevance, 15 were included in the integrative review, including 7 quantitative, 3 qualitative and 5 mixed methods studies. Included studies were all conducted in the hospital intensive care unit. RESULTS: Coping approaches such as self-distraction appear to be associated with lower psychological distress, and avoidant coping and denial associated with increased psychological distress including traumatic stress symptoms. Factors including social support, gender, age, relationship with the patient, decision maker role, and prior ICU experience can influence coping by family members. Uncertainty of the patient's prognosis and recovery heightens the intensity of the emotional response experienced by family members. Such family members appear at increased risk for experiencing depressive symptoms. CONCLUSIONS: From the studies reviewed, it is unclear if coping approaches employed by family members mediate psychological responses such as anxiety and depressive symptoms, or whether coping is a response to psychological stress experienced following hospitalisation of their relative. Future research should focus on the relationship between coping and psychological, physiological and health related behaviours in family members following ICU admission that might contribute towards transient increased health risk during this time. Additionally, future research should explore potential interventions to modify coping and promote family well-being following hospitalisation.