BACKGROUND:The family response to critical illness includes development of adverse psychological outcomes such as anxiety, acute stress disorder, posttraumatic stress, depression, and complicated ...grief. This cluster of complications from exposure to critical care is now entitled postintensive care syndrome–family. Adverse psychological outcomes occur in parents of neonatal and pediatric patients and in family members of adult patients, and may be present for >4 yrs after intensive care unit discharge. Psychological repercussions of critical illness affect the family memberʼs ability to fully engage in necessary care-giving functions after hospitalization.
PREVENTION:It has been suggested that the manner in which healthcare workers communicate with family members and the way in which families are included in care and decision-making, may affect long-term outcomes. Preventive strategies for optimal communication and inclusion in care are reviewed.
ASSESSMENT:Many tools are available to assess the risk for and to diagnose postintensive care syndrome–family conditions during hospitalization and at intervals after discharge.
TREATMENT:Visits after discharge, support groups, and clinics have been proposed for assessing the need for professional referrals as well as for treating family members when psychological illness persists. Studies evaluating these measures are reviewed.
OBJECTIVES:Shared decision making is endorsed by critical care organizations; however, there remains confusion about what shared decision making is, when it should be used, and approaches to promote ...partnerships in treatment decisions. The purpose of this statement is to define shared decision making, recommend when shared decision making should be used, identify the range of ethically acceptable decision-making models, and present important communication skills.
DESIGN:The American College of Critical Care Medicine and American Thoracic Society Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of American College of Critical Care Medicine and American Thoracic Society were included in the statement.
MAIN RESULTS:Six recommendations were endorsed1) DefinitionShared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a shared decision making process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a shared decision making process that includes three main elementsinformation exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable, including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies.
CONCLUSIONS:Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate.
Reports of incidence of physician suicide in the United States (US) are outdated. The aims of this research were to assess incidence, methods, and associated risk factors of physicians compared to ...non-physicians in the general US population. Retrospective suicide data (victim age 25 and over) from the 2012–2016 National Violent Death Reporting System were analyzed to test for differences in rates, methods, and risk factors of male and female physicians to non-physicians. The dataset included 498 physician suicides (403 males and 95 females) and 74,420 non-physicians (57,188 males and 17,232 females). No significant difference was found in suicide incidence between gender and age-adjusted physicians vs. non-physicians, though the female physician rate of suicide appeared higher than female non-physicians. The male to female physician ratio of suicide was about 2:1, whereas the ratio in non-physicians was closer to 4:1. Female physicians used poisoning and hanging most often as a method of suicide, where males used firearms. Depressed mood (as perceived by self or others), mental health problems (defined by a diagnosis of depression, a prescribed antidepressants or toxicology report of antidepressants), poor general medical health, and work-related stressors were more frequently associated with physician than with non-physician suicides. In conclusion, results suggest a possible heightened risk to female physicians, which warrants further investigation. Several physician-specific modifiable suicide risk factors present opportunities for prevention.
•We lack evidence to claim physician and non-physician suicide rates differ.•Among suicide victims, physicians had more mental health problems than non-physicians.•Previous suicide attempt was more likely in female vs. male physicians.•Male-to-female proportion of suicides was lower in physicians (2:1) than others (4:1).
Background
Previous studies have demonstrated nurses are at risk of suicide. This is the first national longitudinal study of U.S. nurse suicide.
Aims
To identify the longitudinal incidence, method, ...and risks of nurse suicide in the United States.
Methods
2005 to 2016 Centers for Disease Control and Prevention National Violent Death Reporting System retrospective analysis of suicide incident rate ratios (IRR).
Results
A total of 1,824 nurse and 152,495 non‐nurse suicides were evaluated. Nurses were at greater risk of suicide than the general population (female IRR 1.395, 95% confidence intervals CI 1.323, 1.470, p < .001; male IRR 1.205, 95% CI 1.083, 1.338, p < .001). Female nurses who completed suicide did so most frequently by pharmacologic poisoning (n = 399, 27.2% vs. n = 8,843, 26.9%), whereby male nurses and the general public used firearms (n = 148, 41.7% vs. n = 57,887, 48.4%). Job problems were more likely in nurses (female odds ratio OR 1.989, 95% CI 1.695, 2.325, p < .001; male OR 1.814, 95% CI 1.380, 2.359, p < .001), as well as mental health history (female OR 1.126, 95% CI 1.013, 1.253, p < .027; male OR 1.302, 95% CI 1.048, 1.614, p = .016) and leaving a suicide note (female OR 1.221, 95% CI 1.096, 1.360, p < .001; male OR 1.756 1.412, 2.181, p < .001).
Linking Evidence to Action
The increased risk of suicide in nurses is congruent with previous reports. The consistency in results increases confidence that findings are generalizable and warrant action. The use of pharmacologic poisoning as a method of suicide, most often by opioids and benzodiazepines, indicates a need for improved identification and treatment of nurses with substance use. Workplace wellness programs need to focus on reducing workplace stressors. Further research is indicated to determine best prevention methods. Policy indications include the need to accurately track gender in nursing, enhance substance use disorder programs, and mandate suicide prevention activities.
This study explored nurse suicide in the United States.
Characteristics were compared between occupations using 2014 National Violent Death Reporting System data.
Female nurse suicides were ...significantly higher (11.97/100,000) than in the female population (7.58/100,000) (p < 0.001); similarly male nurses (39.8/100,000) compared to the male population (28.2/100,000) (p < 0.001). Benzodiazepines and opioids were the most commonly used substances used in clinician suicide.
These results suggest a public health imperative for future research and development of effective preventative strategies for nurses; a largely understudied population.
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•Female nurse suicides were significantly higher than in the female population.•Male nurse suicides were significantly higher than the male population.•Benzodiazepines and opioids were the most common substances used in nurse suicide.•Future research and suicide preventative strategies for nurses are needed.
OBJECTIVEThe aim of this study was to describe the pilot expansion of a proactive suicide risk–screening program, initially designed for physicians, to nurses.
BACKGROUNDThe Healer Education, ...Assessment and Referral (HEAR) program detects at-risk physicians and facilitates referral to mental healthcare. Nothing similar has been available for at-risk nurses. Local nurse suicides served as the catalyst to extend the HEAR program to nurses.
METHODSEducation, outreach, and an encrypted, online, anonymous, proactive risk screening were conducted to identify and refer nurses with depression and suicide risk.
RESULTSDuring the 1st 6 months of the program, 172 of 2475 (7%) nurses completed questionnaires; 74 (43%) were rated as high risk, and another 98 (55%) as moderate risk; 12 (7%) reported current active thoughts or actions of self-harm, and 19 (11%) reported previous suicide attempts. Forty-four (26%) received in-person or verbal counseling, and 17 accepted referral for continued treatment.
CONCLUSIONSAn encrypted, anonymous, proactive risk screening is effective at identifying nurses at risk and referring them to mental healthcare.
Patient and family engagement in the intensive care unit (ICU) is beneficial for patient recovery from critical illness. Yet limited information exists on facilitators and barriers from an ...international perspective.
As part of ongoing work from a task force of the World Federation of Intensive and Critical Care (WFICC) exploring international practices of family engagement from a survey of 345 healthcare clinicians from 43 countries, qualitative analysis was conducted for two open ended questions: 1) What are strategies that you and your colleagues have found helpful to promote patient and family-centered care/engagement in the ICU? and 2) What are potential barriers have you encountered in implementing patient and family-centered care/engagement in the ICU? Thematic content analysis was used to code data to identify major themes of facilitators and barriers of family engagement.
A total of 257 comments were provided from intensivist physicians (n = 107, 31.4%), ICU directors (n = 74, 21.7%), ICU nurse managers (n = 33, 9.7%), and others including fellows, nurse specialists and consultant anesthesiologists. Major themes that emerged related to team engagement, family engagement, communication, leadership, relationships, and structured process.
Highlighting strategies can assist ICU clinicians globally to adopt and promote best practices for family engagement.
•Major themes for promoting family centered care/engagement in the ICU include team engagement, family engagement, communication, and leadership.•Providing written information, family care conferences, and frequent communication were reported more than practices such as open flexible family presence or use of diaries.•While a growing body of literature highlights the benefits, it is evident that dissemination of successful strategies is needed to enlist ICU team members to improve family involvement.
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