Background
Health literacy
Health situations and stress
Methods
Inclusion | Exclusion |
---|---|
Peer-reviewed original research (including systematic reviews) | Not original research (eg. Overview, descriptive review, editorial, opinion piece, conference abstract/paper, thesis, books/book chapters) |
English | Not English |
Explicit measure of patient stress (or parental stress if the patient is a child) in the context of a health facility environment in which stress was measured | No measure of patient stress Not in context of health facility environment Stress as a result of a diagnosis Stress as a result of individual doctor-patient interactions Stress as a result of a procedure (eg. Mechanical ventilation, MRI) Stress of family (other than parents) of patients Interventions that target only stress without examining the environment |
Results
Source | Design | Country | Population & Setting | Measured variables |
---|---|---|---|---|
Patient stressor scales | ||||
Biancofiore et al. 2005 [22] | Cross-sectional survey | Italy | 104 orthotopic liver transplant patients, 103 elective major abdominal surgery patients, 35 ICU nurses & 21 ICU physicians, in a 10-bed post-surgical ICU | ICU Environmental Stressor Scale |
Causey et al. 1998 [35] | Cross-sectional survey | USA | 40 child & adolescent patients admitted to Ackerly Psychiatric Inpatient Unit, at major medical hospital | Child and Adolescent Psychiatric Hospitalisation Stressor Survey |
Dias, Resende & Diniz 2015 [19] | Cross-sectional survey | Brazil | 60 patients in 2 hospital ICUs (30 each) | Assessment Scale for Stressors in the Intensive Care Unit (Brazilian-Portuguese version of Environmental Stressor Questionnaire) |
Hweidi 2007 [39] | Cross-sectional survey | Jordan | 165 patients in 3 CCUs | ICU Environmental Stressor Scale (Arabic version, 42 items) |
Lam Soh et al. 2008 [40] | Cross-sectional survey | Malaysia | 70 ventilated adult patients in 4 ICUs (general ICU, urology ICU, CCU) | Modified Environmental Stressor Questionnaire (translated to Bahasa Malaysia) |
Novaes et al. 1999 [23] | Cross-sectional survey | Brazil | 50 sets of adult patients, respective relatives & health team professionals in a general adult ICU | ICU Environmental Stressor Scale (translated to Portuguese, 40 items) |
Pang & Suen 2008 [41] | Cross-sectional survey | China | 60 patients & 54 critical care nurses in a hospital ICU | ICU Stressor Questionnaire (Chinese) (translated from Environmental Stress Questionnaire) |
Samuelson, Lundberg & Fridlund 2007 [42] | Cross-sectional survey | Sweden | 313 adult patients who had been intubated and mechanically ventilated in 2 general ICUs | ICU Stressful Experiences Questionnaire |
So & Chan 2004 [43] | Cross-sectional survey | China | 50 patients & 92 nurses directly involved in the care of patients in 3 CCUs | ICU Environmental Stressor Scale (Chinese version, 42 items) |
Yava et al. 2011 [44] | Cross-sectional survey | Turkey | 155 adult patients & 152 ICU nurses in ICUs of 2 hospitals | ICU Environmental Stressor Scale (translated to Turkish) |
Yeh et al. 2009 [36] | Cross-sectional survey | Taiwan | 2642 patients, 15 years or older, with end-stage renal disease on dialysis for at least 3 months, at 5 medical centres, 5 regional hospitals, 10 community hospitals & 7 independent haemodialysis centres | Haemodialysis Stressor Scale (Chinese adaption) |
Parental stressor scales | ||||
Board & Ryan-Wenger 2003 [45] | Cross-sectional survey | USA | 31 mothers with child in PICU & 32 mothers with child in GCU, in large 311-bed children’s hospital in Midwest | PSS: PICU |
Board 2004 [46] | Cross-sectional survey | USA | 15 fathers with child in PICU & 10 fathers with child in GCU, in large children’s hospital in Midwest | PSS: PICU |
Franck et al. 2005 [47] | Cross-sectional survey | UK & USA | 257 parents of infants admitted to NICU (184 mothers, 73 fathers), in 9 UK NICUs & 2 US NICUs | PSS: NICU |
Ichijima, Kirk & Hornblow 2011 [48] | Cross-sectional survey | New Zealand & Japan | 121 parents of children requiring NICU hospitalisation, in Christchurch NICU (n = 61) & Tokyo NICU (n = 60) | PSS: NICU (modified version, ‘communication with staff’ excluded, translated to Japanese) |
Lee et al. 2005 [49] | Cross-sectional survey | USA | 55 Chinese or Chinese-American parents of 31 infants in ICU, in tertiary NICU, PICU & cardiac ICU of 3 teaching hospitals | PSS: Infant Hospitalisation-modified (translated to Chinese); Structured interview |
Miles et al. 2002 [50] | Cross-sectional survey | USA | 69 mothers (31 Black, 38 White) of infants with serious life-threatening illness, in NICU, PICU & selected wards of tertiary care hospital in Southeast | PSS: Infant Hospitalisation (adapted from PSS: NICU) |
Nizam & Norzila 2001 [51] | Cross-sectional survey | Malaysia | 94 parents or primary caregivers with children admitted to PICU or PHDU | PSS: PICU (translated to Malay) |
Reid & Bramwell 2003 [52] | Cross-sectional survey | UK | 40 mothers with preterm infants in NICU | PSS: NICU |
Qualitative and experimental studies | ||||
Larsen, Larsen & Birkelund 2014 [37] | Descriptive | Denmark | 20 adult Danish-speaking hospitalised cancer patients, in large university hospital & smaller regional hospital | Participant observation; Individual semi-structured interviews |
Beukeboom, Langeveld & Tanja-Dijkstra 2012 [26] | Controlled trial | The Netherlands | 457 patients (160 ‘no plants’, 150 ‘real plants’, 147 ‘posters’), in Radiology Department waiting room | DV: Experienced stress level measured by combined score on Profile of Mood states (shortened version) & State Trait Anxiety Inventory (Dutch, abridged); Perceived attractiveness of room Intervention: Exposure to nature (real plants vs. posters vs. no plants) |
Cantekin & Tan 2013 [53] | Controlled before and after | Turkey | 100 patients receiving haemodialysis treatment (50 control, 50 experimental), at haemodialysis units of 2 hospitals | DV: Perceived stressors measured by Hemodialysis Stressor Scale Intervention: Music therapy (Turkish art music songs) |
Lilja, Ryden & Fridlund 1998 [38] | Pre-post study | Sweden | 44 breast cancer patients (22 intervention, 22 control) & 50 total hip replacement patients (22 intervention, 28 control), in 400-bed hospital in south-west Sweden | DV: Stress conceptualised by serum cortisol measured 1 day pre-op, day of surgery, day 1 post-op & day 3 post-op Intervention: Preoperative information from anaesthetic nurse |
Muller-Nordhorn et al. 2006 [54] | Pre-post study (parallel) | Germany | 138 adult patients (64 inpatient, 74 outpatient), with indication for elective pacemaker implantation or system change, in teaching hospital or outpatient clinic | DV: Subjective stress measured by German Short Questionnaire on Current Stress Intervention: Pacemaker implantation |
Patient and parental stressors in ICU
Source | Scores (RO, JY) | Main Study Outcomes |
---|---|---|
Patient stressor scales | ||
Biancofiore et al. 2005 [22] | 6, 8 | ICU-related stressors evaluated differently by study groups (p < 0.001) Top 10 stressors for OLT patients (elective abdominal surgery patients, nurses, physicians): 1) being unable to sleep (2, 6, 3), 2) being in pain (3, 2, 1), 3) having tubes in nose/mouth (3, 2, 1), 4) missing husband/wife (5, 9, 9), 5) seeing family & friends only a few minutes a day (1, 7, 11), 6) being tied down by tubes (7, 8, 6), 7) being thirsty (6, 11, 4), 8) hearing the heart alarm (11, 12, 8), 9) having no control over oneself (8, 5, 5), 10) uncomfortable bed/pillow (10, 15, 16) Orthotopic liver transplant (52%) & major abdominal surgery patients (61.4%) used score of 1 (not stressful) more frequently than nurses (19.1%) & physicians (23.4%) (p < 0.001); nurses & physicians more frequently used scores of 2, 3 & 4 |
Causey et al. 1998 [35] | 8, 7 | Highest rated items: 1) being away from and missing all your friends, 2) being away from and missing your family, 3) not being able to exercise, play, or go outside for fresh air, 4) not having enough time to visit or talk with your family and friends, 5) not knowing how long you will be in the hospital, 6) being in a place where all the doors are locked, 7) not being able to have your own things from home, 8) not being able to do the things you normally do at home, 9) being watched too much by staff, 10) not feeling you know enough from your doctor about things that concern you Subscale rankings: 1) family/friends separation, 2) loss of autonomy, 3) psychiatric setting, 4) therapeutic/staff interactions, 5) rules and authority, 6) stigmatisation |
Dias, Resende & Diniz 2015 [19] | 8, 9 | Coronary ICU Major stressors: 1) being in pain, 2) being unable to fulfil family roles, 3) being bored, 4) not being able to sleep, 5) having financial worries, 6) not being in control of yourself, 7) not being able to communicate, 8) hearing people talk about you, 9) being afraid of catching AIDS, 10) only seeing family and friends for a few minutes each day Postoperative ICU Major stressors: 1) being in pain, 2) being unable to fulfil family roles, 3) not being able to communicate, 4) not being able to sleep, 5) being afraid of catching AIDS, 6) having no privacy, 7) being bored, 8) being in a room that is too hot or too cold, 9) having lights on constantly, 10) not being able to move your hands or arms because of IV lines |
Hweidi 2007 [39] | 7, 8 | Top 10 stressors: 1) having tubes in your nose or mouth, 2) being in pain, 3) not able to sleep, 4) hearing the buzzers and alarms from the machinery, 5) being thirsty, 6) not being in control of yourself, 7) unfamiliar and unusual noises, 8) being tied down by tubes, 9) watching treatment being given to other patients, 10) being awakened by nurses |
Lam Soh et al. 2008 [40] | 6, 8 | Top 10 stressors: 1) in pain, 2) stuck with needles, 3) bored, 4) missing husband/wife, 5) room too hot/cold, 6) cannot sleep, 7) cannot move hands/arms because of IV line, 8) tubes in your nose/mouth, 9) staring at tiles in the ceiling, 10) thirsty |
Novaes et al. 1999 [23] | 8, 8 | Top stressors for patients (relatives, team): 1) being in pain (1, 1), 2) being unable to sleep (4, 4), 3) having tubes in nose and/or mouth (2, 2), 4) having no control on oneself (6, 19), 5) being tied down by tubes (3, 3), 6) receiving no explanations about the treatment (11, 9), 7) being unable to move the hands or arms because of IV tubes (5, 21), 8) not knowing when things will be done to you (14, 16), 9) being stuck with needles(19, 7), 10) being thirsty (12, 18) Significant difference between scores rated by patients & health care professionals (p = 0.018) No difference between patients & relatives (p = 0.185), or relatives & health care professionals (p = 0.114) |
Pang & Suen 2008 [41] | 7, 8 | Top stressors for patients (nurses): 1) fear of death (1), 2) being pressurised to consent to treatment (4), 3) being in pain (6), 4) not knowing the length of stay in ICU (18), 5) not being able to communicate (3), 6) fear of other hospital-transmitted diseases (25), 7) not having treatments explained to you (12), 8) financial worries (11), 9) having tubes in your nose or mouth (5), 10) unfamiliar and unusual noises (16) |
Samuelson, Lundberg & Fridlund 2007 [42] | 9, 8 | Top 10 ICU stressors: 1) trouble sleeping, 2) being thirsty, 3) being restricted by tubes and lines, 4) being in pain, 5) trouble falling asleep, 6) difficulty swallowing, 7) spells of terror or panic, 8) not being able to sleep, 9) not being in control, 10) feeling fearful |
So & Chan 2004 [43] | 8, 8 | Top 10 stressors for patients (nurses): 1) being tied down by tubes (1), 2) not being in control of yourself (9), 3) not being able to sleep (11), 4) hearing the buzzers and alarms from the machinery (4), 5) being thirsty (40), 6) being in pain (6), 7) not knowing when to expect things will be done to you (8), 8) having your BP taken often (26), 9) missing your husband or wife (19), 10) having nurses be in too much of a hurry (18) |
Yava et al. 2011 [44] | 8, 8 | Top 10 stressors for patients (nurses): 1) fear of death (1), 2) being thirsty (13), 3) being in pain (2), 4) not being able to sleep (4), 5) having tubes in your nose or mouth (3), 6) hearing other patients cry out (8), 7) being restricted by tubes/lines (11), 8) not being able to move your hands or arms because of IV lines (12), 9) uncomfortable bed or pillow (23), 10) having lights on constantly (18) |
Yeh et al. 2009 [36] | 8, 9 | Patients across 3 types of facility (Veterans/Army (VA); For Profit (FP); Religious Affiliated (RA)) were statistically significantly different in what they perceived as stressful: RA higher stress in physical symptoms (F = 15.01, p < 0.001), dependency on medical staff (F = 19.72, p < 0.001), role ambiguity (F = 6.80, p = 0.001), blood vessel problems (F = 27.70, p < 0.001) VA higher stress in food & fluid restriction (F = 4.49, p = 0.01; mean = 5.27), dependency on medical staff (F = 19.72, p < 0.001) than FP |
Parental stressor scales | ||
Board & Ryan-Wenger 2003 [45] | 7, 7 | Most frequently experienced maternal stressors (> 90%): PICU: (100%) total experience is stressful, injections/shots, sudden sounds of monitor alarms, seeing heart rate on monitor, sound of monitors and equipment; (97%) putting needles in child; (90%) too many different people talking to me, tubes in my child GCU: (97%) putting needles in child; (95%) acting or looking as if in pain; (90%) crying or whining |
Board 2004 [46] | 8, 6 | Mean PSS: PICU (2.06 (SD 0.78)); GCU (1.47 (SD 0.86)) no significant difference Most frequently experienced paternal stressors (> 90%): PICU: (100%) tubes in my child; (93%) putting needles in my child for fluids/procedures or tests, not knowing how best to help my child during this crisis GCU: (90%) putting needles in my child for fluids, procedures or tests |
Franck et al. 2005 [47] | 8, 8 | Metric 1 (stress occurrence) subscale ranking UK (US): 1) parent role alteration (1), 2) infant behaviour and appearance (2), 3) sights and sounds (4), 4) staff behaviour and communication (3) Metric 2 (overall stress) subscale ranking UK (US): 1) parent role alteration (1), 2) infant behaviour and appearance (2), 3) sights and sounds (3), 4) staff behaviour and communication (4) |
Ichijima, Kirk & Hornblow 2011 [48] | 7, 8 | Christchurch maternal stress related to sights & sounds associated with feeding status of infants (p = 0.01): stress higher when tube feeding only Tokyo maternal stress related to sights & sounds negatively correlated with total hours they visited unit (p = 0.004) & infant birth weight (p = 0.025) |
Lee et al. 2005 [49] | 9, 8 | Subscale rankings: 1) child appearance, 2) parental role, 3) HCP’s communication, 4) HCP’s behaviour, 5) ICU environment Structured interviews - 7 themes: Lack of confidence; Self-blame; Worry about upsetting own parents; Lack of resources; Stress related to communication issues; Stress related to cultural issues; Other issues: changing bed spaces/hospital units, difficulty accessing doctors |
Miles et al. 2002 [50] | 8, 8 | Subscale rankings: 1) infant appearance and behaviour, 2) parental role alteration, 3) sights and sounds Top 5 stressors: Black mothers: 1) breathing problems, 2) seeing child in pain, 3) can’t protect from pain, 4) can’t respond to me, 5) separated from baby White mothers: 1) seeing child in pain, 2) breathing problems, 3) can’t protect from pain, 4) separated from baby, 5) can’t respond to me |
Nizam & Norzila 2001 [51] | 7, 8 | Subscale rankings: 1) parental roles, 2) child’s behaviour and emotional response, 3) sight and sound, 4) child’s appearance, 5) procedure, 6) staff’s communication, 7) staff’s behaviour No significant difference of means between parents of 2 units Fathers higher than mothers in staff’s communications (3.15 vs 2.50, p < 0.017) Staff’s communication higher if child not ventilated prior (2.94 vs 3.26, p = 0.05) |
Reid & Bramwell 2003 [52] | 7, 8 | Subscale ranking: 1) relationship with infant, 2) appearance and behaviour, 3) sights and sounds, 4) staff behaviours and communication (many items n/a in > 2/3 participants – excluded from further analyses) Younger mothers, less education, poorer SES - more stress on environment subscale, but not significant on multiple regression ‘Sights & sounds’ had moderate correlation with infant variables: days to full feeds, length of stay |
Qualitative and experimental studies | ||
Larsen, Larsen & Birkelund 2014 [37] | 8, 9 | Themes: Healing & non-healing accommodation; Withholding information due to enforced public privacy; Seeking refuge from fellow patients; Single-bed room or multiple-bed room; Acceptance of & resignation to the hospital environment |
Beukeboom, Langeveld & Tanja-Dijkstra 2012 [26] | 8, 8 | Marginal effect on exposure to nature, F (2,451) = 2.33, p = 0.099, np^2 = 0.01; Tukey post hoc test: real plants & posters both lower stress (p’s = 0.04) Real plants vs. posters no difference Mean (SD) experienced stress: no plants = 2.51 (0.87); real plants = 2.27 (0.79); posters = 2.27 (0.86) Partial mediation by perceived attractiveness of room |
Cantekin & Tan 2013 [53] | 7, 8 | Both psychosocial (mean difference 7.4, p < 0.01) and physiological (mean difference 3.7, p < 0.001) stress rated lower after music therapy; no mean change in control group Overall stress lower in experimental group (mean difference 12.5, p < 0.01) and higher in control group (mean difference 2.6, p < 0.001) |
Lilja, Ryden & Fridlund 1998 [38] | 7, 7 | No significant differences in cortisol seen between intervention & control groups, for both breast cancer & total hip replacement patients |
Muller-Nordhorn et al. 2006 [54] | 8, 6 | In both inpatients & outpatients, subjective stress decreased from pre-op, to day 1, to day 3/4 - no significant differences in stress between groups at any time |