Critical illness and care in the intensive care unit: the experiences of next-of-kin

Abstract

Background: Critical illness and care in intensive care units (ICU) have a serious impact not only on patients, but also on their families. This study aimed at better understanding the immediate experiences of next-of-kin when visiting patients with a life threatening condition in the ICU. Methods: Semi-standardized qualitative interviews were conducted with caregivers of patients with ARDS (acute respiratory distress syndrome). 35 families were approached during ICU visits; 17 next-of-kin (26-71 years; 9 women) participated in the study. Interview transcripts were analyzed by computer-assisted thematic analysis drawing on the stress-strain-concept. Findings: Stressors were found to occur when organizing ICU visits, during these visits and at home. Many next-of-kin made enormous efforts to realize regular visits. The experience of the patient’s critical state, his/her dependence on medical devices and his/her inability to communicate evoked stress during ICU visits. Next-of-kin had to make decisions in lieu of patients while being exposed to a highly unfamiliar situation over which they had little control. Several stressors occurring at home were also described, including the state of continuous alertness and the need to report on the patient’s health. Interviewees` accounts of stressors were remarkably consistent. However, they expressed varying levels and manifestations of strains. Discussion: This study comprehensively explored how next-of-kin experienced the ICU stay of family members. Manifold stressors were identified: Some of them are inherent to the situation of witnessing a life-threatening condition of close relatives, while others are nested within the context of the health care system and are thus potentially modifiable.