Background
Bereavement in the intensive care unit
Long-term grief in bereaved relatives
Supporting relatives of deceased ICU patients
Aim
Hypotheses
Methods
Setting
Study population
Methodology
Procedure
Multicomponent nurse-led bereavement support intervention
RE-AIM | Characteristics | Level | Data collection |
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Reach | Baseline characteristics | Individual | Demographic data cohort 1 and 2 |
Inclusion rate | Individual | Medical files | |
Efficacy | Comparing the study outcomes (before, after; corrected for covariates) | Individual | Measurements in cohort 1 and 2 |
Adoption | Proportion of ICU professionals using intervention elements | Organizational | Self-composed questionnaire among ICU professionals |
Implementation | Number of intervention elements received by relatives | Individual | Self-composed items added to questionnaire measured in cohort 2 |
Experiences with implementation | Organizational | Self-composed questionnaire among ICU professionals | |
Maintenance | Long-term adoption of the intervention | Organizational | Semi-structured interview with ICU manager |
Study cohorts and time points
Primary outcomes
Secondary outcomes
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Anxiety and depression; measured with the Dutch version of the ‘Hospital Anxiety and Depression Scale’ (HADS), that includes to 7 items on the subscales tapping ‘Anxiety’ and ‘Depression’ respectively [41, 42]. These subscales are reliable and valid measures of mental health status with items concerning symptoms of psychological well-being. Scores range from 0 to 21, categorized as ‘normal’ (0 to 7); ‘mild’ (8 to 10); and ‘moderate to severe’ (11–21).
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Posttraumatic stress; measured with the 21-item Dutch version of the ‘Impact of Events Scale-Revised’ (IES-R) [43]. This measuring instrument is used worldwide to self-report the frequency of intrusive and avoidant phenomena after a variety of traumatic experiences. The reliability of the Dutch version of the IES is adequate across the various stressors [44]. Scores range from 0 to 88, categorized as ‘low risk’ (0 to 11); ‘moderate risk’ (12 to 32); and ‘high risk’ (≥ 33).
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Experiences with care; measured with items derived from the ‘Consumer Quality Index Relatives in the ICU’ (CQI R-ICU) [45] and ‘The Quality of Dying and Death questionnaire’ (QODD) [46, 47], includes 30 items in total. Both instruments have been developed and validated in Dutch, and report high internal consistency reliability and construct validity. The subscales measure aspects of communication, quality of dying and death, and quality of support to relatives.
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Questions to evaluate which intervention elements were actually received and how they were appreciated will be added to the questionnaires for cohort 2.
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The applicability and opinions of ICU professionals will be measured with a self-composed questionnaire including items to evaluate the fit of the intervention to daily practice and to assess the implementation process. Also, a semi-structured interview with one ICU manager will be performed for deepening the evaluation and describe learned lessons before further dissemination. These measures administered to ICU staff will be performed between October 2019 and March 2020, when the development and implementation of the nurse-led multicomponent intervention to support bereavement in relatives in the IC has been finished.
Data handling
Statistical analysis
Study status
Discussion
Limitations and related risk strategies
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Educational sessions for all ICU nurses presenting the new tools and discussing communication strategies;
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Information strategies such as an informational pamphlet and reminders in a weekly newsletter;
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Champions in each ICU team, empowered by a two-day training in loss and bereavement care;
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Regular interactions between the investigators, the local champions and the team members to discuss difficulties;
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Including the nurse managers in advocating the bereavement tools if doomed necessary during daily start-up;
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Close collaboration with the department of Public Health and Erasmus MC University Medical Center, with extended expertise in this domain of palliative care and used practices among nurses and other allied healthcare providers.