Öz
Aim: With this study
as benefit from experiences of the family have long term intensive care
patients to determine the needs of patient families and define the
interventions that contributing development of the services.
Material and Methods: This study, a qualitative phenomenological, was executed between
September 29 - October 10, 2017. In this study semi-structured interviews was
performed by face to face with the families, chosen by teleological sampling,
have long tıme intensive care patients. Interviews had been continued until the
data saturation were obtained (n=13). The data were analyzed by content
analysis method.
Results: Most of
the patient families found this period abrasive from psychosocial aspect. In
this context, at the end of the interviews 4 main and 7 sub-themes were formed.
“Ambiguity”, “A Situation Between Hope and Hopelessness” and “A Process Make
Complex Feelings” are the subtitles of the first main theme of “Thoughts and
Feelings With Process” as founded, “Changing in your needs”, “Experiences with
Personnel Work in Intensive Care Units”, “Hospital Process” and from “Economic
Perspective” are the subtitles of the second theme of “Difficulties in the
Process” as determined.
Conclusion: End of the study, it has been determined that the families have long
term intensive care patients need psychosocial and economic support.
Furthermore, establishing the long term acute care hospital in Turkey like
abroad that could service patients who need mechanic ventilation contribute
both psychosocial situation of the patient families and reducing health costs.
Anahtar Kelimeler
Critical illness family caregivers intensive care units burden of illness
Kaynakça
- 1. Carson SS. Know your long-term care hospital. Chest. 2007; 131(1): 2-5.
- 2. Scheinhorn DJ, Hassenpflug MS, Votto JJ, Chao DC, Epstein SK, Doig GS, et al. Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation. Chest. 2007; 131(1): 76-84.
- 3. Szubski CR, Tellez A, Klika AK, Xu M, Kattan MW, Guzman JA, et al. Predicting discharge to a long-term acute care hospital after admission to an intensive care unit. Am J Crit Care. 2014; 23(4): e46-53.
- 4. Carson SS, Bach PB. The epidemiology and costs of chronic critical illness. Crit Care Clin. 2002; 18(3): 461-76.
- 5. Kahn JM. The evolving role of dedicated weaning facilities in critical care. Intensive Care Med. 2010; 36(1): 8-10.
- 6. Zilberberg MD, Shorr AF. Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: implications for budgets, plant and personnel planning. BMC Health Serv Res. 2008; 8: 242.
- 7. Nierman DM. A structure of care for the chronically critically ill. Crit Care Clin. 2002; 18(3): 477-91.
- 8. Nasraway SA, Button GJ, Rand WM, Hudson-Jinks T, Gustafson M. Survivors of catastrophic illness: Outcome after direct transfer from intensive care to extended care facilities. Crit Care Med. 2000; 28(1): 19-25.
- 9. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders' conference. Crit Care Med. 2012; 40(2): 502-9.
- 10. Gürkan A. Bütüncül yaklaşım: yoğun bakımda hastası olan aile üyeleri. Yoğun Bakım Hemşireliği Dergisi. 2009; 13(1): 1-5.
- 11. Ünver V. Yoğun Bakım Ünitesinde Hastası Olan Ailelerin Gereksinimlerinin Saptanması. Yoğun Bakım Hemşireliği Dergisi. 2003; 7(1): 75-81.
- 12. Sekmen K, Hatipoğlu S. Yoğun bakım ünitesi teknolojik ortamının hasta ve ailesi üzerine etkileri. Yoğun Bakım Hemşireliği Dergisi. 1999; 3(1): 22-6.
- 13. Bo M, Fonte G, Pivaro F, Bonetto M, Comi C, Giorgis V, et al. Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients. Geriatr Gerontol Int. 2016; 16(3): 314-21.
- 14. Creswell JW Research Design: Qualitative Quantitative and Mixed Methods Approaches. 4th ed. Thousand Oaks CA: Sage; 2014.
- 15. Halm MA, Titler MG, Kleiber C, Johnson SK, Montgomery LA, Craft MJ, et al. Behavioral responses of family members during critical illness. Clin Nurs Res. 1993; 2(4): 414-37.
- 16. Kuluski K, Im J, McGeown M. "It's a waiting game" a qualitative study of the experience of careers of patients who require an alternate level of care. BMC Health Serv Res. 2017; 17(1): 1-10. doi: 10.1186/s12913-017-2272-6
- 17. Kleiber C, Halm M, Titler M, Montgomery LA, Johnson SK, Nicholson A, et al. Emotional responses of family members during a critical care hospitalization. Am J Crit Care. 1994; 3(1): 70-6.
- 18. Anderson WG, Arnold RM, Angus DC, Bryce CL. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. Journal of General Internal Medicine. 2008; 23(11): 1871-6.
- 19. Siegel MD, Hayes E, Vanderwerker LC, Loseth DB, Prigerson HG. Psychiatric illness in the next of kin of patients who die in the intensive care unit. Critical Care Medicine. 2008; 36(6): 1722-8.
- 20. Jones C, Skirrow P, Griffiths RD, Humphris G, Ingleby S, Eddleston J, et al. Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Medicine. 2004; 30(3): 456-60.
- 21. Petrinec AB, Daly BJ. Post-traumatic stress symptoms in post-ICU family members: Review and methodological challenges. Western Journal of Nursing Research. 2016; 38(1): 57-78.
- 22. Mullen JE. Supporting families of technology-dependent patients hospitalized in a pediatric intensive care unit. AACN Adv Crit Care. 2008; 19(2): 125-9.
- 23. McAdam JL, Dracup KA, White DB, Fontaine DK, Puntillo KA. Symptom experiences of family members of intensive care unit patients at high risk for dying. Crit Care Med. 2010; 38(4): 1078-85.
- 24. Van Horn E, Tesh A. The effect of critical care hospitalization on family members: Stress and responses. Dimensions of critical care nursing. 2000; 19(4): 40-9.
- 25. Hebert RS, Dang Q, Schulz R. Preparedness for the death of a loved one and mental health in bereaved caregivers of patients with dementia: Findings from the REACH study. J Palliat Med. 2006; 9(3): 683-93.
- 26. Chiambretto P, Moroni L, Guarnerio C, Bertolotti G, Prigerson HG. Prolonged grief and depression in caregivers of patients in vegetative state. Brain Injury. 2010; 24(4): 581-8.
- 27. Goudarzi F, Abedi H, Zarea K, Ahmadi F. Multiple Victims: The Result of caring patients in vegetative state. Iranian Red Crescent Medical Journal. 2015; 17(6): e23571.
- 28. Caicedo C. Health and functioning of families of children with special health care needs cared for in home care, long-term care, and medical day care settings. Journal of Developmental and Behavioral Pediatrics. 2015; 36(5): 352-61.
- 29. Gosseries O, Demertzi A, Ledoux D, Bruno M-A, Vanhaudenhuyse A, Thibaut A, et al. Burnout in healthcare workers managing chronic patients with disorders of consciousness. Brain Injury. 2012; 26(12): 1493-9.
- 30. Mammen J, Laude C, Costello B. Relational sustainability: environments for long-term critical care patients. Crit Care Nurs Q. 2014; 37(1): 53-66.
Öz
Amaç: Bu çalışma ile
yoğun bakım ünitesinde uzun süredir hastası bulunan ailelerin bu süreçteki
deneyimlerinden yola çıkarak, hasta ailelerinin ihtiyaçlarının tespit edilmesi
ve bu alandaki hizmetlerin geliştirilmesine katkı sağlayacak
stratejilerin/müdahalelerin belirlenmesi amaçlanmıştır.
Gereç ve
Yöntemler:
Niteliksel türde fenomenolojik bir araştırma olan bu çalışma, 29 Eylül - 10
Ekim 2017 tarihleri arasında yürütülmüştür. Araştırmada amaçsal örneklem ile
seçilmiş uzun süreli yoğun bakım ünitesinde hastası bulunan ailelerle yüz yüze
yarı-yapılandırılmış görüşmeler yapılmıştır.
Görüşmelere veri doygunluğu elde edilene kadar devam edilmiştir (n=13).
Çalışma sonucunda elde edilen veriler içerik analiz yöntemi ile analiz edilmiştir.
Bulgular: Hasta
yakınlarının büyük çoğunluğu bu süreci psikososyal yönden yıpratıcı olarak
bulmuşlardır. Bu bağlamda görüşmeler sonucunda dört ana, yedi alt tema
oluşturulmuştur; Birinci ana tema “Süreç ile ilgili düşünce ve duygular” ın alt
temaları “Belirsizlik”, "Umut ve umutsuzluğun arasındaki bir durum” ve
“Karmaşık duygular hissettiren üzüntülü bir süreç” olarak bulunmuştur. İkinci
ana tema olan “Süreçte yaşanan zorluklar” ın alt temaları “Kendi ihtiyaçların
değişmesi”, “Yoğun bakımda çalışan personel ile ilgili deneyimler”, “Hastane
süreçleri” ve “Ekonomik” olarak tespit edilmiştir. Üçüncü ana tema “Psikososyal
destek ihtiyacı”, dördüncü ana tema ise “Hizmete ilişkin görüş ve öneriler”
olarak bulunmuştur.
Sonuç: Araştırma
sonucunda; hastaları uzun süre yoğun bakım ünitesinde olan hasta yakınlarının
bu süreçte psikososyal ve ekonomik yönden desteğe ihtiyacı olduğu tespit
edilmiştir. Ayrıca yurt dışında bulunan uzun süreli akut bakım hastanelerine
benzer uzun süre mekanik ventilasyon desteği gerektiren hastaların
bakılabileceği tesislerin Türkiye’de oluşturulması ve yaygınlaştırılması hem
hasta ailelerine hem de buna ilişkin sağlık maliyetlerinin azaltılmasında katkı
sağlayacağı düşünülmektedir.
Anahtar Kelimeler
Kritik hastalık aile bakıcı yoğun bakım üniteleri hastalık yükü
Kaynakça
- 1. Carson SS. Know your long-term care hospital. Chest. 2007; 131(1): 2-5.
- 2. Scheinhorn DJ, Hassenpflug MS, Votto JJ, Chao DC, Epstein SK, Doig GS, et al. Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation. Chest. 2007; 131(1): 76-84.
- 3. Szubski CR, Tellez A, Klika AK, Xu M, Kattan MW, Guzman JA, et al. Predicting discharge to a long-term acute care hospital after admission to an intensive care unit. Am J Crit Care. 2014; 23(4): e46-53.
- 4. Carson SS, Bach PB. The epidemiology and costs of chronic critical illness. Crit Care Clin. 2002; 18(3): 461-76.
- 5. Kahn JM. The evolving role of dedicated weaning facilities in critical care. Intensive Care Med. 2010; 36(1): 8-10.
- 6. Zilberberg MD, Shorr AF. Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: implications for budgets, plant and personnel planning. BMC Health Serv Res. 2008; 8: 242.
- 7. Nierman DM. A structure of care for the chronically critically ill. Crit Care Clin. 2002; 18(3): 477-91.
- 8. Nasraway SA, Button GJ, Rand WM, Hudson-Jinks T, Gustafson M. Survivors of catastrophic illness: Outcome after direct transfer from intensive care to extended care facilities. Crit Care Med. 2000; 28(1): 19-25.
- 9. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders' conference. Crit Care Med. 2012; 40(2): 502-9.
- 10. Gürkan A. Bütüncül yaklaşım: yoğun bakımda hastası olan aile üyeleri. Yoğun Bakım Hemşireliği Dergisi. 2009; 13(1): 1-5.
- 11. Ünver V. Yoğun Bakım Ünitesinde Hastası Olan Ailelerin Gereksinimlerinin Saptanması. Yoğun Bakım Hemşireliği Dergisi. 2003; 7(1): 75-81.
- 12. Sekmen K, Hatipoğlu S. Yoğun bakım ünitesi teknolojik ortamının hasta ve ailesi üzerine etkileri. Yoğun Bakım Hemşireliği Dergisi. 1999; 3(1): 22-6.
- 13. Bo M, Fonte G, Pivaro F, Bonetto M, Comi C, Giorgis V, et al. Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients. Geriatr Gerontol Int. 2016; 16(3): 314-21.
- 14. Creswell JW Research Design: Qualitative Quantitative and Mixed Methods Approaches. 4th ed. Thousand Oaks CA: Sage; 2014.
- 15. Halm MA, Titler MG, Kleiber C, Johnson SK, Montgomery LA, Craft MJ, et al. Behavioral responses of family members during critical illness. Clin Nurs Res. 1993; 2(4): 414-37.
- 16. Kuluski K, Im J, McGeown M. "It's a waiting game" a qualitative study of the experience of careers of patients who require an alternate level of care. BMC Health Serv Res. 2017; 17(1): 1-10. doi: 10.1186/s12913-017-2272-6
- 17. Kleiber C, Halm M, Titler M, Montgomery LA, Johnson SK, Nicholson A, et al. Emotional responses of family members during a critical care hospitalization. Am J Crit Care. 1994; 3(1): 70-6.
- 18. Anderson WG, Arnold RM, Angus DC, Bryce CL. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. Journal of General Internal Medicine. 2008; 23(11): 1871-6.
- 19. Siegel MD, Hayes E, Vanderwerker LC, Loseth DB, Prigerson HG. Psychiatric illness in the next of kin of patients who die in the intensive care unit. Critical Care Medicine. 2008; 36(6): 1722-8.
- 20. Jones C, Skirrow P, Griffiths RD, Humphris G, Ingleby S, Eddleston J, et al. Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Medicine. 2004; 30(3): 456-60.
- 21. Petrinec AB, Daly BJ. Post-traumatic stress symptoms in post-ICU family members: Review and methodological challenges. Western Journal of Nursing Research. 2016; 38(1): 57-78.
- 22. Mullen JE. Supporting families of technology-dependent patients hospitalized in a pediatric intensive care unit. AACN Adv Crit Care. 2008; 19(2): 125-9.
- 23. McAdam JL, Dracup KA, White DB, Fontaine DK, Puntillo KA. Symptom experiences of family members of intensive care unit patients at high risk for dying. Crit Care Med. 2010; 38(4): 1078-85.
- 24. Van Horn E, Tesh A. The effect of critical care hospitalization on family members: Stress and responses. Dimensions of critical care nursing. 2000; 19(4): 40-9.
- 25. Hebert RS, Dang Q, Schulz R. Preparedness for the death of a loved one and mental health in bereaved caregivers of patients with dementia: Findings from the REACH study. J Palliat Med. 2006; 9(3): 683-93.
- 26. Chiambretto P, Moroni L, Guarnerio C, Bertolotti G, Prigerson HG. Prolonged grief and depression in caregivers of patients in vegetative state. Brain Injury. 2010; 24(4): 581-8.
- 27. Goudarzi F, Abedi H, Zarea K, Ahmadi F. Multiple Victims: The Result of caring patients in vegetative state. Iranian Red Crescent Medical Journal. 2015; 17(6): e23571.
- 28. Caicedo C. Health and functioning of families of children with special health care needs cared for in home care, long-term care, and medical day care settings. Journal of Developmental and Behavioral Pediatrics. 2015; 36(5): 352-61.
- 29. Gosseries O, Demertzi A, Ledoux D, Bruno M-A, Vanhaudenhuyse A, Thibaut A, et al. Burnout in healthcare workers managing chronic patients with disorders of consciousness. Brain Injury. 2012; 26(12): 1493-9.
- 30. Mammen J, Laude C, Costello B. Relational sustainability: environments for long-term critical care patients. Crit Care Nurs Q. 2014; 37(1): 53-66.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2019 |
| Gönderilme Tarihi | 14 Mart 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 9 Sayı: 3 |
